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Métodos Terapéuticos y Terapias MTCI
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1.
Int J Cardiol ; 406: 132043, 2024 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-38614366

RESUMEN

BACKGROUND: Calcium channel blockers (CCB) are the first effective therapy for vasoreactive patients with idiopathic pulmonary arterial hypertension (IPAH). However, the advent of modern PAH-specific drugs may undermine the role of vasoreactivity tests and CCB treatment. We aimed to clarify the effect of acute vasoreactivity testing and CCB on patients with IPAH receiving PAH-specific treatment. METHODS: We retrospectively investigated consecutive patients with IPAH (n = 136) diagnosed between 2000 and 2020 and collected data from patients who underwent acute vasoreactivity testing using inhaled nitric oxide (NO). The effects of vasoreactivity testing and CCB therapy were reviewed. Long-term survival was analysed using the Kaplan-Meier method. RESULTS: Acute vasoreactivity testing was performed in 49% of patients with IPAH (n = 67), including 23 patients (34%) receiving PAH-specific therapy without vasoreactivity testing. Eight patients (12%), including three patients (4.4%) receiving PAH-specific therapy, presented acute responses at vasoreactivity testing. They received high-dose CCB therapy (CCB monotherapy for five patients [7.5%] and CCB therapy and PAH-specific therapy for three patients [4.4%]). They presented a significant improvement in clinical parameters and near-normalisation of haemodynamics (mean pulmonary arterial pressure decreased from 46 [interquartile range: 40-49] to 19.5 [interquartile range: 18-23] mmHg [P < .001] at 1-year follow-up). All eight vasoreactive responders receiving CCB therapy showed better long-term survival than non-responders treated with PAH-specific therapy (P < .001). CONCLUSIONS: CCB therapy benefited patients with IPAH who showed acute response to vasoreactivity testing using inhaled NO, even when receiving modern PAH-specific therapy. Acute vasoreactive responders may benefit more from CCB than from PAH-specific therapy.


Asunto(s)
Bloqueadores de los Canales de Calcio , Humanos , Femenino , Masculino , Estudios Retrospectivos , Bloqueadores de los Canales de Calcio/uso terapéutico , Bloqueadores de los Canales de Calcio/administración & dosificación , Persona de Mediana Edad , Adulto , Hipertensión Arterial Pulmonar/tratamiento farmacológico , Hipertensión Arterial Pulmonar/fisiopatología , Resultado del Tratamiento , Estudios de Seguimiento
2.
Integr Cancer Ther ; 23: 15347354241237520, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38622853

RESUMEN

INTRODUCTION: Although breast cancer is common worldwide, if diagnosed early and treated on time, the probability of recovery is high and patients often experience a long life. Reducing the quality of life is a common side effect in patients. Melatonin may have an important role in fatigue, sleep disorders and, as a result, the health-related quality of life (HRQoL) in people. About 184 patients with breast cancer were enrolled in 2 groups: intervention with daily melatonin intake of 18 mg for 3 years (93 patients) and the control group with placebo intake (91 patients). Health-related quality of life and the effect of melatonin on increasing that were evaluated with the EORTC QLQ-C30 questionnaire, third edition at the beginning, 2 months later and 3 years after the beginning of the study. RESULTS: The general score of the HRQoL was significantly different both in the passage of time and in the comparative study of the 2 groups, and it was better in the melatonin group (P < .05). CONCLUSION: Long-term use of 18 mg of melatonin for 3 years in patients with non-metastatic breast cancer can lead to an increase in the patients' quality of life.


Asunto(s)
Neoplasias de la Mama , Melatonina , Humanos , Femenino , Calidad de Vida , Neoplasias de la Mama/terapia , Melatonina/uso terapéutico , Estudios de Seguimiento , Encuestas y Cuestionarios
4.
Pediatr Blood Cancer ; 71(6): e30966, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38556719

RESUMEN

BACKGROUND: Oral mucositis (OM) is a painful and common complication of hematopoietic stem cell transplant (HSCT). The Children's Oncology Group recently published guidelines recommending photobiomodulation (PBM) for preventing and treating OM in pediatric HSCT patients. However, this is a rarely used intervention in pediatric hospitals. PROCEDURE: Patients undergoing allogeneic HSCT, or autologous HSCT for a neuroblastoma diagnosis, had PBM administered from the first day of conditioning to transplant Day +20. We successfully developed a standardized treatment protocol and workflow to ensure consistent and uniform delivery of PBM. In addition, clinical patient data were compared before and after PBM implementation. RESULTS: The administration of PBM at our center was feasible, but required dedicated staff. A registered nurse (RN) was determined to be the best fit to deliver PBM. Sixty-two patients received PBM from October 2022 to September 2023; patients from 2021 before PBM implementation were used for comparison. Patients receiving PBM were more likely (p = .03) to engage in teeth brushing (56/62 = 90%) compared to baseline (61/81 = 75%). Mean days of OM decreased from 11.3 to 9 days; patients who received PBM were less likely (p < .001) to be discharged on total parental nutrition (TPN) (11/62 = 18%) compared to baseline (50/82 = 61%). OM-related supportive care costs (TPN and patient-controlled anesthesia [PCA]) were lower (p = .02) for those who received PBM (median cost = $31,229.87 vs. $37,370.66). CONCLUSION: PBM, as the standard of care in the pediatric HSCT population, is safe, feasible, and well-tolerated. At our center, a dedicated RN was critical to providing standardized treatment and ensuring sustainability.


Asunto(s)
Trasplante de Células Madre Hematopoyéticas , Terapia por Luz de Baja Intensidad , Estomatitis , Humanos , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Estomatitis/etiología , Estomatitis/prevención & control , Estomatitis/terapia , Niño , Masculino , Femenino , Terapia por Luz de Baja Intensidad/métodos , Preescolar , Adolescente , Acondicionamiento Pretrasplante/efectos adversos , Acondicionamiento Pretrasplante/métodos , Lactante , Estudios de Seguimiento , Pronóstico
5.
Dtsch Med Wochenschr ; 149(9): e48-e57, 2024 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-38621680

RESUMEN

After acute infection with the SARS-CoV-2 virus, up to 10 % of affected individuals suffer from long-term health impairments, also referred to as "Post-COVID". In Germany, specialized outpatient clinics have been established to care for patients with Post-COVID. A structured survey of the care situation is not yet available, but essential for a demand-oriented care. The present study aimed to systematically assess and describe structural and process-related aspects of care, and to perform an inventory and needs analysis of Post-COVID outpatient clinics in Germany.An online survey was developed assessing the structure and organization of the outpatient clinics, service offerings and networking of care from the perspective of the outpatient clinic directors. A total of 95 outpatient clinics were identified, and an invitation to participate in the online survey was sent via e-mail to the directors of the outpatient clinics. Data were collected between February and May 2022. Descriptive data analysis was performed.A total of 28 outpatient clinic managers (29 %) took part in the survey. Participants were between 32 and 66 years old, and 61 % (n = 17) were male. The outpatient clinics were most frequently affiliated with the specialties of pneumology (n = 10; 36 %), internal medicine, psychiatric and psychosomatic medicine, and neurology (n = 8; 29 %, respectively). Among the outpatient clinic directors, 64 % (n = 18) stated that the time spent waiting for an appointment was more than one month. Utilization (n = 25; 89 %), appointment demand (n = 26; 93 %), and the need for more Post-COVID outpatient clinics (n = 20; 71 %) were rated as high by the outpatient clinic directors. Nearly all directors reported networking with in-clinic facilities (n = 27; 96 %), with primary care physicians and with specialists in private practice (n = 21; 75 %, respectively).The main focus of care is pneumology. Internal medicine, psychiatry/psychosomatics and neurology are also equally represented. Our data further suggest a high demand for Post-COVID outpatient clinics and the need to expand this care offer.


Asunto(s)
COVID-19 , Humanos , Masculino , Adulto , Persona de Mediana Edad , Anciano , Femenino , Estudios de Seguimiento , COVID-19/epidemiología , COVID-19/terapia , SARS-CoV-2 , Instituciones de Atención Ambulatoria , Medicina Interna
6.
BMC Ophthalmol ; 24(1): 191, 2024 Apr 25.
Artículo en Inglés | MEDLINE | ID: mdl-38664659

RESUMEN

BACKGROUND: To assess the age and timeline distribution of ocular axial length shortening among myopic children treated with photobiomodulation therapy in the real world situations. METHODS: Retrospective study of photobiomodulation therapy in Chinese children aged 4 to 13 years old where axial length measurements were recorded and assessed to determine effectiveness at two age groups (4 ∼ 8 years old group and 9 ∼ 13 years old group). Data was collected from myopic children who received photobiomodulation therapy for 6 ∼ 12 months. Effectiveness of myopia control was defined as any follow-up axial length ≤ baseline axial length, confirming a reduction in axial length. Independent t-test was used to compare the effectiveness of the younger group and the older group with SPSS 22.0. RESULTS: 342 myopic children were included with mean age 8.64 ± 2.20 years and baseline mean axial length of 24.41 ± 1.17 mm. There were 85.40%, 46.30%, 71.20% and 58.30% children with axial length shortening recorded at follow-up for 1 month, 3 months, 6 months and 12 months, respectively. With respect to the axial length shortened eyes, the mean axial length difference (standard deviation) was - 0.039 (0.11) mm, -0.032 (0.11) mm, -0.037 (0.12) mm, -0.028 (0.57) mm at 1, 3, 6, and 12-month follow-up, respectively. Greater AL shortening was observed among the older group who had longer baseline axial lengths than the younger group (P < 0.001). CONCLUSIONS: Overall myopia control effectiveness using photobiomodulation therapy was shown to be age and time related, with the maximum absolute reduction in axial elongation being cumulative.


Asunto(s)
Longitud Axial del Ojo , Terapia por Luz de Baja Intensidad , Miopía , Humanos , Estudios Retrospectivos , Niño , Femenino , Masculino , Miopía/fisiopatología , Miopía/radioterapia , Adolescente , Preescolar , Terapia por Luz de Baja Intensidad/métodos , Refracción Ocular/fisiología , Estudios de Seguimiento
7.
Endocrinol Metab (Seoul) ; 39(2): 288-299, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38437824

RESUMEN

BACKGRUOUND: Current research has not investigated the effect of thyroid-stimulating hormone suppression therapy with levothyroxine on the risk for developing subsequent primary cancers (SPCs). This study aimed to investigate the association between levothyroxine dosage and the risk for SPCs in thyroid cancer patients. METHODS: We conducted a nationwide population-based retrospective cohort study form Korean National Health Insurance database. This cohort included 342,920 thyroid cancer patients between 2004 and 2018. Patients were divided into the non-levothyroxine and the levothyroxine groups, the latter consisting of four dosage subgroups according to quartiles. Cox proportional hazard models were performed to evaluate the risk for SPCs by adjusting for variables including cumulative doses of radioactive iodine (RAI) therapy. RESULTS: A total of 17,410 SPC cases were observed over a median 7.3 years of follow-up. The high-dose levothyroxine subgroups (Q3 and Q4) had a higher risk for SPC (adjusted hazard ratio [HR], 1.14 and 1.27; 95% confidence interval [CI], 1.05-1.24 and 1.17- 1.37; respectively) compared to the non-levothyroxine group. In particular, the adjusted HR of stomach (1.31), colorectal (1.60), liver and biliary tract (1.95), and pancreatic (2.48) cancers were increased in the Q4 subgroup. We consistently observed a positive association between high levothyroxine dosage per body weight and risk of SPCs, even after adjusting for various confounding variables. Moreover, similar results were identified in the stratified analyses according to thyroidectomy type and RAI therapy, as well as in a subgroup analysis of patients with good adherence. CONCLUSION: High-dose levothyroxine use was associated with increased risk of SPCs among thyroid cancer patients regardless of RAI therapy.


Asunto(s)
Supervivientes de Cáncer , Neoplasias de la Tiroides , Tiroxina , Humanos , Tiroxina/administración & dosificación , Tiroxina/uso terapéutico , Neoplasias de la Tiroides/tratamiento farmacológico , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto , República de Corea/epidemiología , Supervivientes de Cáncer/estadística & datos numéricos , Anciano , Neoplasias Primarias Secundarias/epidemiología , Neoplasias Primarias Secundarias/etiología , Factores de Riesgo , Relación Dosis-Respuesta a Droga , Estudios de Cohortes , Estudios de Seguimiento
8.
Heart Lung Circ ; 33(4): 450-459, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38453606

RESUMEN

BACKGROUND & AIMS: Cardiogenic shock (CS) is a serious complication of acute myocardial infarction (MI) and is associated with significant mortality. We describe a contemporary, real-world cohort of patients with ST-elevation MI (STEMI) and CS, including 30-day mortality and clinically relevant predictors of mortality. METHODS: All patients presenting with STEMI who were treated with percutaneous coronary intervention (PCI) in New Zealand (2016 to 2020) were identified from the Aotearoa New Zealand All Cardiology Services Quality Improvement (ANZACS-QI) registry and stratified based on their Killip class on arrival to the cardiac catheterisation laboratory. Primary outcome was 30-day all-cause mortality. Multivariable analysis was used to identify predictors of mortality prior to PCI and to develop a mortality scoring system. RESULTS: In total, 6,649 patients were identified, including 192 (2.9%) Killip IV (CS) patients. Thirty-day mortality was 47.5% in patients with CS, 14.6% in those with heart failure without shock, and 3% in those without heart failure. Independent predictors of 30-day mortality for patients with CS were: estimated glomerular filtration rate <60 mL/min/1.73m2 (relative risk [RR] 1.89, 95% confidence interval [CI] 1.39-2.58), cardiac arrest (RR 1.54, 95% CI 1.15-2.06), diabetes (RR 1.31, 95% CI 1.01-1.70), female sex (RR 1.32, 95% CI 1.01-1.72), femoral arterial access (RR 1.42, 95% CI 1.06-1.90) and left main stem culprit (RR 2.16, 95% CI 1.65-2.84). A multivariable Shock score was developed which predicts 30-day mortality with good global discrimination (area under the curve 0.79, 95% CI 0.73-0.85). CONCLUSION: In this national cohort, the 30-day mortality for STEMI patients presenting with CS treated with PCI remains high, at nearly 50%. The ANZACS-QI Shock score is a promising tool for mortality risk stratification prior to PCI but requires further validation.


Asunto(s)
Intervención Coronaria Percutánea , Sistema de Registros , Infarto del Miocardio con Elevación del ST , Choque Cardiogénico , Humanos , Choque Cardiogénico/mortalidad , Choque Cardiogénico/terapia , Choque Cardiogénico/etiología , Infarto del Miocardio con Elevación del ST/mortalidad , Infarto del Miocardio con Elevación del ST/cirugía , Infarto del Miocardio con Elevación del ST/terapia , Infarto del Miocardio con Elevación del ST/complicaciones , Intervención Coronaria Percutánea/métodos , Masculino , Femenino , Anciano , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Tasa de Supervivencia/tendencias , Factores de Riesgo , Estudios Retrospectivos , Medición de Riesgo/métodos , Estudios de Seguimiento , Factores de Tiempo , Pronóstico
9.
Medicina (Kaunas) ; 60(3)2024 Mar 06.
Artículo en Inglés | MEDLINE | ID: mdl-38541163

RESUMEN

Background and Objectives: This paper aims to assess the role of laser therapy in periodontitis through an innovative approach involving computational prediction and advanced modeling performed through network analysis (Gaussian graphical models-GGMs) and structural equations (SEM). Materials and Methods: Forty patients, exhibiting periodontal pockets with a minimum depth of 5 mm, were randomly divided into two groups: a control group and a laser group. Four specific indicators were measured for each tooth, namely periodontal pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), and plaque index (PI), and the mean of six measured values was recorded at five time markers (baseline, 6 months, 1 year, 2 years, and 4 years). The assessment algorithm included enrollment, measurements, and differential non-surgical periodontal treatment, according to the group allocation. Scaling, root planing, and chlorhexidine 1% were conducted for the control group, and scaling, root planing and erbium, chromium:yttrium-scandium-gallium-garnet (Er,CR:YSGG) laser therapy were conducted for the laser group. Results: The main results highlight that the addition of laser treatment to scaling and root planing led to notable clinical improvements, decreasing the PPD values, reducing the BOP scores, and increasing the CAL. Conclusions: Notable relationships between the specific indicators considered were highlighted by both the GGMs and by SEM, thus confirming their suitability as proxies for the success of periodontal treatment.


Asunto(s)
Terapia por Láser , Terapia por Luz de Baja Intensidad , Periodontitis , Humanos , Análisis de Clases Latentes , Periodontitis/radioterapia , Periodontitis/cirugía , Terapia por Láser/métodos , Aplanamiento de la Raíz/métodos , Estudios de Seguimiento
10.
Bone Joint J ; 106-B(4): 312-318, 2024 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-38555951

RESUMEN

The advent of modular porous metal augments has ushered in a new form of treatment for acetabular bone loss. The function of an augment can be seen as reducing the size of a defect or reconstituting the anterosuperior/posteroinferior columns and/or allowing supplementary fixation. Depending on the function of the augment, the surgeon can decide on the sequence of introduction of the hemispherical shell, before or after the augment. Augments should always, however, be used with cement to form a unit with the acetabular component. Given their versatility, augments also allow the use of a hemispherical shell in a position that restores the centre of rotation and biomechanics of the hip. Progressive shedding or the appearance of metal debris is a particular finding with augments and, with other radiological signs of failure, should be recognized on serial radiographs. Mid- to long-term outcomes in studies reporting the use of augments with hemispherical shells in revision total hip arthroplasty have shown rates of survival of > 90%. However, a higher risk of failure has been reported when augments have been used for patients with chronic pelvic discontinuity.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Enfermedades Óseas Metabólicas , Prótesis de Cadera , Humanos , Artroplastia de Reemplazo de Cadera/efectos adversos , Prótesis de Cadera/efectos adversos , Porosidad , Acetábulo/cirugía , Reoperación , Metales , Falla de Prótesis , Estudios Retrospectivos , Estudios de Seguimiento
11.
BMC Psychiatry ; 24(1): 225, 2024 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-38532374

RESUMEN

BACKGROUND: Preliminary evidence shows promising treatment outcomes at short-term follow-up for intensive posttraumatic stress disorder (PTSD) treatment, but long-term follow-up studies are sparse. This study is a sequel to a previous pilot study and open trial, set out to investigate treatment outcomes at 12-month follow-up for outpatients completing an 8-day intensive treatment for PTSD. METHODS: All patients were diagnosed with PTSD and had multiple previous psychotherapy attempts (M = 3.1). Patients were assessed at pre-treatment, post-treatment, 3- and 12-month follow-up. Of 35 treated patients, 32 (91.4%) attended the long-term follow-up assessment. The treatment programme combined prolonged exposure therapy, eye movement desensitization and reprocessing, and physical activity. RESULTS: The effect sizes indicated large reductions in symptoms of PTSD, depression, anxiety, interpersonal problems, and well-being. Changes in functioning showed a small-medium effect. Results were stable across the follow-up period. The treatment response rates showed that 46-60% of patients achieved recovery with respect to PTSD symptoms, and that 44-48% no longer met diagnostic criteria for PTSD. CONCLUSIONS: Time-limited and concentrated outpatient treatment for PTSD can yield large and enduring positive outcomes. Controlled trials are needed to establish relative efficacy. TRIAL REGISTRATION: The study was registered in Current Research Information System In Norway (Cristin). Cristin-project-ID: 654,790. Date of registration: 18.03.2019.


Asunto(s)
Desensibilización y Reprocesamiento del Movimiento Ocular , Terapia Implosiva , Trastornos por Estrés Postraumático , Humanos , Desensibilización y Reprocesamiento del Movimiento Ocular/métodos , Estudios de Seguimiento , Terapia Implosiva/métodos , Pacientes Ambulatorios , Proyectos Piloto , Trastornos por Estrés Postraumático/diagnóstico , Resultado del Tratamiento
12.
Investig Clin Urol ; 65(2): 139-147, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38454823

RESUMEN

PURPOSE: To compare perioperative, functional, and safety outcomes between thulium fiber laser enucleation of the prostate (ThuFLEP) and bipolar enucleation of the prostate performed by a single surgeon with use of propensity score (PS)-matched analysis. MATERIALS AND METHODS: Data were from 675 patients, 422 of whom underwent ThuFLEP and bipolar enucleation by a single highly experienced surgeon. ThuFLEP was performed with Fiberlase U1 (IRE Polus Ltd.). Perioperative parameters, safety, and functional outcomes, such as International Prostate Symptom Score (IPSS), quality of life (QoL), postvoid residual volume (PVR), and maximum urinary flow rate (Qmax) were assessed. To control for selection bias, a 1:1 PS-matched analysis was carried out using the following variables as covariates: total prostate volume, preoperative IPSS and early sphincter release. RESULTS: Of 422 patients, 370 (87.7%) underwent ThuFLEP and 52 (12.3%) underwent bipolar enucleation. Operation, enucleation, and morcellation time were comparable between groups before and after PS-matched analysis (p=0.954, p=0.474, p=0.362, respectively). Functional parameters (IPSS, QoL, PVR, Qmax) were also comparable between groups at every time point before and after PS matching. Significant improvements in IPSS, QoL score, Qmax, and PVR were observed during the 24-month follow-up period for both ThuFLEP and bipolar enucleation without any significant differences between groups. Early and late postoperative complications before and after PS-matched analysis were similar. CONCLUSIONS: ThuFLEP was comparable to bipolar enucleation in perioperative characteristics, improvement in voiding parameters, and complication rates. Both procedures were shown to be effective and safe in the management of benign prostatic hyperplasia.


Asunto(s)
Terapia por Láser , Hiperplasia Prostática , Cirujanos , Resección Transuretral de la Próstata , Masculino , Humanos , Próstata/cirugía , Tulio/uso terapéutico , Calidad de Vida , Estudios de Seguimiento , Resección Transuretral de la Próstata/métodos , Puntaje de Propensión , Resultado del Tratamiento , Terapia por Láser/efectos adversos , Terapia por Láser/métodos , Rayos Láser , Hiperplasia Prostática/cirugía
13.
J Orthop Traumatol ; 25(1): 12, 2024 Mar 02.
Artículo en Inglés | MEDLINE | ID: mdl-38430413

RESUMEN

BACKGROUND: Alumina particles from the grit blasting of Ti-alloy stems are suspected to contribute to aseptic loosening. An alumina-reduced stem surface was hypothesized to improve osseointegration and show comparable short-term outcomes to those of a standard stem. METHODS: In this prospective, double-blind, randomized trial, 26 standard (STD) and 27 experimental new technology (NT) stems were implanted. The latter were additionally treated by acid etching and ice blasting to remove alumina particles from the grit-blasting process. Follow-up occurred at 12 and 24 months. Bone mineral density (BMD) around the stem was measured by a dual-energy x-ray absorptiometry device (DEXA). Radiographs were reviewed for alterations. Clinical scoring comprised the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Harris Hip Score (HHS). Survival rates were calculated up to 50 months. RESULTS: Lower mean BMD and more severe cortical hypertrophies were found in the NT group. At 12 months, radiolucent lines were observed mostly in the metaphyseal zone for both groups, with a progression tendency in the NT group at 24 months. At 12 months, pain scores and the WOMAC total and physical activity scores were significantly lower in the NT group, without any differences thereafter. The number of NT stem revisions amounted to 6 (24%) and 11 (41%) at 24 and 50 months, respectively. CONCLUSION: In the NT group, unexpected catastrophic failure rates of 41% caused by early aseptic loosening were noted within 50 months. Compared with the STD stems, NT stems lead to poor clinical and radiographic results. LEVEL OF EVIDENCE: II. TRIAL REGISTRATION: NCT05053048.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Prótesis de Cadera , Humanos , Absorciometría de Fotón , Óxido de Aluminio , Artroplastia de Reemplazo de Cadera/métodos , Estudios de Seguimiento , Estudios Prospectivos , Diseño de Prótesis , Falla de Prótesis , Resultado del Tratamiento , Método Doble Ciego
14.
Ann Intern Med ; 177(4): 428-438, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38467003

RESUMEN

BACKGROUND: Although calcium and vitamin D (CaD) supplementation may affect chronic disease in older women, evidence of long-term effects on health outcomes is limited. OBJECTIVE: To evaluate long-term health outcomes among postmenopausal women in the Women's Health Initiative CaD trial. DESIGN: Post hoc analysis of long-term postintervention follow-up of the 7-year randomized intervention trial of CaD. (ClinicalTrials.gov: NCT00000611). SETTING: A multicenter (n = 40) trial across the United States. PARTICIPANTS: 36 282 postmenopausal women with no history of breast or colorectal cancer. INTERVENTION: Random 1:1 assignment to 1000 mg of calcium carbonate (400 mg of elemental calcium) with 400 IU of vitamin D3 daily or placebo. MEASUREMENTS: Incidence of colorectal, invasive breast, and total cancer; disease-specific and all-cause mortality; total cardiovascular disease (CVD); and hip fracture by randomization assignment (through December 2020). Analyses were stratified on personal supplement use. RESULTS: For women randomly assigned to CaD versus placebo, a 7% reduction in cancer mortality was observed after a median cumulative follow-up of 22.3 years (1817 vs. 1943 deaths; hazard ratio [HR], 0.93 [95% CI, 0.87 to 0.99]), along with a 6% increase in CVD mortality (2621 vs. 2420 deaths; HR, 1.06 [CI, 1.01 to 1.12]). There was no overall effect on other measures, including all-cause mortality (7834 vs. 7748 deaths; HR, 1.00 [CI, 0.97 to 1.03]). Estimates for cancer incidence varied widely when stratified by whether participants reported supplement use before randomization, whereas estimates on mortality did not vary, except for CVD mortality. LIMITATION: Hip fracture and CVD outcomes were available on only a subset of participants, and effects of calcium versus vitamin D versus joint supplementation could not be disentangled. CONCLUSION: Calcium and vitamin D supplements seemed to reduce cancer mortality and increase CVD mortality after more than 20 years of follow-up among postmenopausal women, with no effect on all-cause mortality. PRIMARY FUNDING SOURCE: National Heart, Lung, and Blood Institute of the National Institutes of Health.


Asunto(s)
Enfermedades Cardiovasculares , Fracturas de Cadera , Neoplasias , Femenino , Humanos , Estados Unidos/epidemiología , Anciano , Calcio/uso terapéutico , Estudios de Seguimiento , Distribución Aleatoria , Calcio de la Dieta , Suplementos Dietéticos , Vitamina D/uso terapéutico , Vitaminas/uso terapéutico , Neoplasias/epidemiología , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Enfermedades Cardiovasculares/tratamiento farmacológico , Fracturas de Cadera/epidemiología , Fracturas de Cadera/prevención & control
15.
BMC Health Serv Res ; 24(1): 298, 2024 Mar 06.
Artículo en Inglés | MEDLINE | ID: mdl-38448882

RESUMEN

BACKGROUND: To propose a community-embedded follow-up management model to provide health services for elderly patients with osteoporosis who live alone. METHODS: Researchers randomly selected 396 people with osteoporosis living alone from five communities in Nantong, China, for the study. These participants were randomly assigned to control and intervention groups. Twenty-four community physicians in five communities provided professional support based on a community-embedded follow-up management model. Participants completed quantitative questionnaires at baseline and after the 6-month follow-up intervention, and some participants underwent semi-structured face-to-face interviews. The primary outcome is the effectiveness of the community-embedded follow-up management model in improving the quality of life of elderly patients with osteoporosis living alone. Based on an objective quantitative assessment, the qualitative study explains and adds essential components of this community-based follow-up management model. RESULTS: The quantitative study showed that scores in physical functioning, ability to perform daily activities, self-efficacy, and mental status were significantly improved in the intervention group compared to the control group (p < 0.05). The most significant improvements were found in "mental status" (p = 0.012) and "self-care skills" (p = 0.003). The qualitative study reported the essential elements of a community healthcare model for older people living alone with osteoporosis, including professional support, personalized services, social support, and empowerment. CONCLUSIONS: Community-embedded follow-up management meets the need for elderly patients with osteoporosis living alone. It helps to improve health perception, promote physical and mental health, and optimize the quality of life in this population. Personalized services and professional support are two major contributing factors to effective embedded follow-up management in the community.


Asunto(s)
Osteoporosis , Calidad de Vida , Anciano , Humanos , Estudios de Seguimiento , Servicios de Salud , Osteoporosis/terapia , Atención Primaria de Salud
16.
Eur J Hum Genet ; 32(4): 426-434, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38316953

RESUMEN

GEMIN5 exerts key biological functions regulating pre-mRNAs intron removal to generate mature mRNAs. A series of patients were reported harboring mutations in GEMIN5. No treatments are currently available for this disease. We treated two of these patients with oral Coenzyme Q10 (CoQ10), which resulted in neurological improvements, although MRI abnormalities remained. Whole Exome Sequencing demonstrated compound heterozygosity at the GEMIN5 gene in both cases: Case one: p.Lys742* and p.Arg1016Cys; Case two: p.Arg1016Cys and p.Ser411Hisfs*6. Functional studies in fibroblasts revealed a decrease in CoQ10 biosynthesis compared to controls. Supplementation with exogenous CoQ10 restored it to control intracellular CoQ10 levels. Mitochondrial function was compromised, as indicated by the decrease in oxygen consumption, restored by CoQ10 supplementation. Transcriptomic analysis of GEMIN5 patients compared with controls showed general repression of genes involved in CoQ10 biosynthesis. In the rigor mortis defective flies, CoQ10 levels were decreased, and CoQ10 supplementation led to an improvement in the adult climbing assay performance, a reduction in the number of motionless flies, and partial restoration of survival. Overall, we report the association between GEMIN5 dysfunction and CoQ10 deficiency for the first time. This association opens the possibility of oral CoQ10 therapy, which is safe and has no observed side effects after long-term therapy.


Asunto(s)
Ataxia , Enfermedades Mitocondriales , Debilidad Muscular , Ubiquinona , Ubiquinona/deficiencia , Adulto , Humanos , Ubiquinona/genética , Ubiquinona/uso terapéutico , Ubiquinona/metabolismo , Estudios de Seguimiento , Enfermedades Mitocondriales/tratamiento farmacológico , Enfermedades Mitocondriales/genética , Mutación , Proteínas del Complejo SMN/genética
17.
Curr Oncol ; 31(2): 660-671, 2024 01 24.
Artículo en Inglés | MEDLINE | ID: mdl-38392042

RESUMEN

Multidisciplinary strategies have transformed the management of advanced ovarian cancer. We aimed to evaluate the effectiveness of paclitaxel in hyperthermic intraperitoneal chemotherapy (HIPEC) following surgical cytoreduction for ovarian peritoneal metastases in a randomized phase III trial conducted between August 2012 and December 2019. Seventy-six patients were randomized to either the HIPEC or no HIPEC group. Although median values for the primary endpoints (recurrence-free survival (RFS) and overall survival (OS)) revealed superior outcomes for the HIPEC (RFS: 23 months, OS: 48 months) over the control group (RFS: 19 months, OS: 46 months), these differences were not statistically significant (p = 0.22 and p = 0.579). Notably, the HIPEC group demonstrated significantly higher 5-year OS and 3-year RFS rates (47.2% and 47.5%) compared to patients without HIPEC (34.5% and 21.3%). Stratification according to Peritoneal Surface Disease Severity Score (PSDSS) showed improved OS and RFS for patients with lower PSDSS (I-II) in the HIPEC-treated group (p = 0.033 and p = 0.042, respectively). The Clavien-Dindo classification of adverse event grades revealed no significant differences between HIPEC and controls (p = 0.482). While overall results were not statistically significant, our long-term follow-up emphasized the potential benefit of HIPEC-associated cytoreduction with paclitaxel, particularly in selected ovarian cancer patients with lower PSDSS indices.


Asunto(s)
Hipertermia Inducida , Neoplasias Ováricas , Neoplasias Peritoneales , Femenino , Humanos , Paclitaxel/uso terapéutico , Quimioterapia Intraperitoneal Hipertérmica , Terapia Combinada , Procedimientos Quirúrgicos de Citorreducción , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Peritoneales/cirugía , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Estudios de Seguimiento , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/cirugía
18.
J Antimicrob Chemother ; 79(4): 826-834, 2024 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-38334373

RESUMEN

BACKGROUND: Decolonization treatment of MRSA carriers is recommended in Denmark, except in households with MRSA-positive children <2 years old (wait-and-see approach). OBJECTIVES: To investigate a wait-and-see approach in children 2-5 years old, and the effect of decolonization treatment of MRSA carriage in all children <6 years old. PATIENTS AND METHODS: In this retrospective follow-up study, we included MRSA carriers <6 years old in the Capital Region of Denmark from 2007 to 2021. Data were collected from laboratory information systems and electronic patient records. We divided children into age groups of <2 years or 2-5 years and decolonization treatment versus no treatment. Treatment was chlorhexidine body washes and nasal mupirocin, sometimes supplemented with systemic antibiotics. Children were followed until becoming MRSA free, or censoring. The probability of becoming MRSA free was investigated with Cox regression (higher HRs indicate faster decolonization). RESULTS: Of 348 included children, 226 were <2 years old [56/226 (25%) received treatment] and 122 were 2-5 years old [90/122 (74%) received treatment]. Multivariable analyses did not show a larger effect of decolonization treatment versus no treatment in <2-year-olds (HR 0.92, 95% CI 0.52-1.65) or 2-5-year-olds (HR 0.54, 95% CI 0.26-1.12). Without treatment, 2-5-year-olds tended to clear MRSA faster than <2-year-olds (HR 1.81, 95% CI 0.98-3.37). CONCLUSIONS: We did not find a larger effect of decolonization treatment versus no treatment in children <6 years old, and 2-5-year-olds tended to become MRSA free faster than <2-year-olds. These results support a wait-and-see approach for all children <6 years old, but further studies are needed.


Asunto(s)
Staphylococcus aureus Resistente a Meticilina , Infecciones Estafilocócicas , Niño , Humanos , Preescolar , Estudios de Seguimiento , Estudios Retrospectivos , Infecciones Estafilocócicas/tratamiento farmacológico , Portador Sano/tratamiento farmacológico , Mupirocina/uso terapéutico , Mupirocina/farmacología , Antibacterianos/uso terapéutico , Antibacterianos/farmacología , Clorhexidina/uso terapéutico , Clorhexidina/farmacología
19.
BMJ Open ; 14(2): e079435, 2024 02 07.
Artículo en Inglés | MEDLINE | ID: mdl-38326255

RESUMEN

OBJECTIVES: The study aimed to conduct a follow-up of all broad-based training (BBT) trainees who participated in the original evaluation completed in 2017. The follow-up study explored the impact of BBT on career decisions, sustained benefits and unintended disadvantages of the programme, and views on the future of training. DESIGN: Scoping interviews informed the design of an online survey. The interview transcripts were analysed thematically. The survey was piloted with six volunteers and sent out to all former BBT trainees. Data from the survey were transferred to Excel and SPSS for analysis. The open-text comments on the survey were subject to a thematic content analysis. SETTING: Participants were working in general practice, paediatrics, psychiatry or medicine. PARTICIPANTS: Eight former BBT trainees participated in the scoping interviews. Interview participants were selected to ensure a diversity of current specialties and to represent all three BBT cohorts. All former BBT trainees were invited to complete the survey (n=118) and 70 replied. RESULTS: The benefits of BBT were sustained over time: participants were confident in their career decisions, took a holistic approach to care and capitalised on their experiences in other specialties in their current roles. A minority of trainees also experienced temporary challenges when they joined a specialty training programme after completing the BBT. Whatever their specialty, experience in core medicine, paediatrics, psychiatry and general practice was valued. Disadvantages were short-lived (catching up on transition specialty training) or affected a minority (impact on sense of belonging). CONCLUSIONS: The BBT programme supported the development of generalist doctors. Greater attention needs to be given to training secondary care doctors who take a holistic view of the patient and navigate their specialist care.


Asunto(s)
Medicina General , Médicos , Humanos , Niño , Estudios de Seguimiento , Medicina Familiar y Comunitaria , Reino Unido , Selección de Profesión
20.
BMC Musculoskelet Disord ; 25(1): 158, 2024 Feb 20.
Artículo en Inglés | MEDLINE | ID: mdl-38378564

RESUMEN

BACKGROUND: One of the major contributors to disability in Knee osteoarthritis (KOA) patients is weakness in the Quadriceps Femoris muscle. Neuromuscular electrical stimulation (NMES) has been used in rehabilitation for patients suffering from muscle weakness. Thus, the purpose of the study was to assess the effectiveness of NMES and exercise therapy, for improving pain, muscle weakness and function among patients with KOA. METHODS: A randomized controlled trial was conducted with 75 female patients diagnosed with KOA. Participants were divided into three intervention groups: NMES-only, exercise therapy (Exs) alone, and a combination of NMES and exercise (NMES + Exs). All patients underwent 12 supervised treatment sessions, three times a week. Outcome measures included pain intensity measured by visual analog scale (VAS), knee flexion range of motion (FROM), thigh muscle girth (TG), thickness of the Vastus Medialis Oblique (VMO), timed up and go test (TUG), six-minute walk test (6MWT), and WOMAC scores. Statistical analyses (ANOVA and Kruskal-Wallis) methods were done to compare the amounts at the baseline, immediately after treatment and after 12 weeks. RESULTS: The NMES group exhibited a significant reduction in pain at the 12-week follow-up compared to the other groups(p = 0.022). The NMES + Exs group showed better outcomes in terms of FROM, TG, and VMO thickness post-intervention (p < 0.0001, p < 0.004, p = 0.003, respectively) and at the 12-week follow-up (p < 0.0001, p < 0.0001, p < 0.0001, respectively). Additionally, NMES was superior in improving TUG and 6MWT post-intervention (p < 0.0001, p = 0.038, respectively) and during the follow-up assessments (p < 0.0001, p = 0.029, respectively). The NMES + Exs group achieved better WOMAC stiffness scores at both post-intervention and follow-up evaluations (p < 0.0001, p < 0.0001, respectively). Furthermore, at the 12-week follow-up, NMES + Exs group outperformed the others in WOMAC pain and function subscales (p = 0.003, p = 0.017, respectively), while the NMES group demonstrated better WOMAC total scores compared to the other groups (p = 0.007). CONCLUSION: The combination of NMES and exercise seems to be an efficient approach for managing KOA, as it enhances knee flexion range and TG, increases VMO thickness, and improves WOMAC scores. On the other hand, NMES alone was found to be effective in improving the physical function of KOA patients. TRIAL REGISTRATION: IRCT20101228005486N7 (06-02-2020).


Asunto(s)
Terapia por Estimulación Eléctrica , Osteoartritis de la Rodilla , Humanos , Femenino , Músculo Cuádriceps , Terapia por Estimulación Eléctrica/métodos , Estudios de Seguimiento , Equilibrio Postural , Estudios de Tiempo y Movimiento , Dolor , Debilidad Muscular , Estimulación Eléctrica
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