Robotic Biofeedback for Post-Stroke Gait Rehabilitation: A Scoping Review.

This review aims to recommend directions for future research on robotic biofeedback towards prompt post-stroke gait rehabilitation by investigating the technical and clinical specifications of biofeedback systems (BSs), including the complementary use with assistive devices and/or physiotherapist-oriented cues. A literature search was conducted from January 2019 to September 2022 on Cochrane, Embase, PubMed, PEDro, Scopus, and Web of Science databases. Data regarding technical (sensors, biofeedback parameters, actuators, control strategies, assistive devices, physiotherapist-oriented cues) and clinical (participants' characteristics, protocols, outcome measures, BSs' effects) specifications of BSs were extracted from the relevant studies. A total of 31 studies were reviewed, which included 660 stroke survivors. Most studies reported visual biofeedback driven according to the comparison between real-time kinetic or spatiotemporal data from wearable sensors and a threshold. Most studies achieved statistically significant improvements on sensor-based and clinical outcomes between at least two evaluation time points. Future research should study the effectiveness of using multiple wearable sensors and actuators to provide personalized biofeedback to users with multiple sensorimotor deficits. There is space to explore BSs complementing different assistive devices and physiotherapist-oriented cues according to their needs. There is a lack of randomized-controlled studies to explore post-stroke stage, mental and sensory effects of BSs.

Vibrotactile biofeedback devices in Parkinson's disease: a narrative review.

Parkinson's disease (PD) is often associated with a vast list of gait-associated disabilities, for which there is still a limited pharmacological/surgical treatment efficacy. Therefore, alternative approaches have emerged as vibrotactile biofeedback systems (VBS). This review aims to focus on the technologies supporting VBS and identify their effects on improving gait-associated disabilities by verifying how VBS were applied and validated with end-users. It is expected to furnish guidance to researchers looking to enhance the effectiveness of future vibrotactile cueing systems. The use of vibrotactile cues has proved to be relevant and attractive, as positive results have been obtained in patients' gait performance, suitability in any environment, and easy adherence. There seems to be a preference in developing VBS to mitigate freezing of gait, to improve balance, to overcome the risk of fall, and a prevalent use to apply miniaturized wearable actuators and sensors. Most studies implemented a biofeedback loop able to provide rescue strategies during or after the detection of a gait-associated disability. However, there is a need of more clinical evidence and inclusion of experimental sessions to evaluate if the biofeedback was effectively integrated into the patients' motor system.

Short- and Long-Term Effects of a Scapular-Focused Exercise Protocol for Patients with Shoulder Dysfunctions-A Prospective Cohort.

Current clinical practice lacks consistent evidence in the management of scapular dyskinesis. This study aims to determine the short- and long-term effects of a scapular-focused exercise protocol facilitated by real-time electromyographic biofeedback (EMGBF) on pain and function, in individuals with rotator cuff related pain syndrome (RCS) and anterior shoulder instability (ASI). One-hundred and eighty-three patients were divided into two groups (n = 117 RCS and n = 66 ASI) and guided through a structured exercise protocol, focusing on scapular dynamic control. Values of pain and function (shoulder pain and disability index (SPADI) questionnaire, complemented by the numeric pain rating scale (NPRS) and disabilities of the arm, shoulder, and hand (DASH) questionnaire) were assessed at the initial, 4-week, and 2-year follow-up and compared within and between. There were significant differences in pain and function improvement between the initial and 4-week assessments. There were no differences in the values of DASH 1st part and SPADI between the 4-week and 2-year follow-up. There were no differences between groups at the baseline and long-term, except for DASH 1st part and SPADI (p < 0.05). Only 29 patients (15.8%) had a recurrence episode at follow-up. These results provide valuable information on the positive results of the protocol in the short- and long-term.

Wearable Biofeedback Improves Human-Robot Compliance during Ankle-Foot Exoskeleton-Assisted Gait Training: A Pre-Post Controlled Study in Healthy Participants.

The adjunctive use of biofeedback systems with exoskeletons may accelerate post-stroke gait rehabilitation. Wearable patient-oriented human-robot interaction-based biofeedback is proposed to improve patient-exoskeleton compliance regarding the interaction torque's direction (joint motion strategy) and magnitude (user participation strategy) through auditory and vibrotactile cues during assisted gait training, respectively. Parallel physiotherapist-oriented strategies are also proposed such that physiotherapists can follow in real-time a patient's motor performance towards effective involvement during training. A preliminary pre-post controlled study was conducted with eight healthy participants to conclude about the biofeedback's efficacy during gait training driven by an ankle-foot exoskeleton and guided by a technical person. For the study group, performance related to the interaction torque's direction increased during (p-value = 0.07) and after (p-value = 0.07) joint motion training. Further, the performance regarding the interaction torque's magnitude significantly increased during (p-value = 0.03) and after (p-value = 68.59×10-3) user participation training. The experimental group and a technical person reported promising usability of the biofeedback and highlighted the importance of the timely cues from physiotherapist-oriented strategies. Less significant improvements in patient-exoskeleton compliance were observed in the control group. The overall findings suggest that the proposed biofeedback was able to improve the participant-exoskeleton compliance by enhancing human-robot interaction; thus, it may be a powerful tool to accelerate post-stroke ankle-foot deformity recovery.

Sex selection in late Iberian infant burials: Integrating evidence from morphological and genetic data.

OBJECTIVE: The aim of this study was to analyze the infant burials found inside Iberian homes in relation to a possible case of sex selection. METHODS: The study included the remains of 11 infant individuals buried under the 10 houses excavated in the late Iberian village of Camp de les Lloses (Tona, Barcelona, Spain). Sex was determined using genetic analysis. RESULTS: Our results showed that almost all the burials were females. However, the age interval of death was wide enough to weaken the premise of infanticide, and the burials probably represent cases of natural death. DISCUSSION: Infanticide in its different forms has long been argued as an explanation for the infant remains found throughout various burial sites. Many authors thought that infanticide, mainly femicide, was the main method of population control in ancient times. However, there is no anthropological evidence (age distribution and sex analyzed genetically) to support the intentional killing of females in this or in other cases. We hypothesized that there was a positive selection for females to be buried inside the houses, probably related to their benefactor roles.

Finding Parameters around the Abdomen for a Vibrotactile System: Healthy and Patients with Parkinson's Disease.

Freezing of Gait (FOG) is one of the most disabling gait disorders in Parkinson's Disease (PD), for which the efficacy of the medication is reduced, highlighting the use of non-pharmacological solutions. In particular, patients present less difficulties in overcoming FOG when using feedback and especially with Biofeedback Systems. In this study it is intended to detect the frequency threshold and the minimum interval of perception of the vibrotactile feedback, through a proposed wearable system, a waistband. Experimental tests were carried out that considered a temporal, spatial and spatiotemporal context, for which 15 healthy and 15 PD patients participated. It was detected as threshold frequency 180 Hz and for minimum interval of vibration perception 250 ms. The identification of this threshold frequency and this interval will allow us to select the frequency and the minimum interval of vibration to be used in a Vibrotactile Biofeedback Device for patients with PD, in order to help them to overcome FOG.

Optimization of ß-cyclodextrin-based extraction of antioxidant and anti-browning activities from thyme leaves by response surface methodology.

Thyme (Thymus vulgaris) has been demonstrated to extend the shelf-life of food products, being also a potential source of bioactive compounds. The aim of this research was to optimize the ultrasound assisted extraction employing ß-cyclodextrin aqueous solutions as no-contaminant technology and Response Surface Methodology to obtain thyme extracts with the maximum antioxidant capacity. The optimal extraction conditions were: a solution of ß-ciclodextrin 15 mM, an ultrasonic treatment time of 5.9 min at a temperature of 36.6 °C. They resulted in an extract with a polyphenolic content of 189.3 mg GAE/mL, an antioxidant activity (DPPH) of 14.8 mg GAE/mL, and ferric reducing/antioxidant power (FRAP) of 3.3 mg GAE/mL. Interestingly, the extract demonstrated to inhibit the production of Maillard browning products and can be considered a potential antiglycant agent. The obtained data is important for developing eco-friendly technologies in order to obtain natural antioxidant extracts with a potential inhibitory capacity of Maillard glycation reaction.

Selenium, selenoproteins and selenometabolites in mothers and babies at the time of birth.

The deficiency of Se, an essential micronutrient, has been implicated in adverse pregnancy outcomes. Our study was designed to determine total serum Se, selenoproteins (extracellular glutathione peroxidase (GPx-3), selenoprotein P (SeP)), selenoalbumin (SeAlb) and selenometabolites in healthy women and their newborns at delivery. This cross-sectional study included eighty-three healthy mother-baby couples. Total Se and Se species concentrations were measured in maternal and umbilical cord sera by an in-series coupling of two-dimensional size-exclusion and affinity HPLC. Additional measurements of serum SeP concentration and of serum GPx-3 enzyme activity were carried out using ELISA. Total Se concentration was significantly higher in maternal serum than in cord serum (68·9 (sd 15·2) and 56·1 (sd 14·6) µg/l, respectively; P<0·01). There were significant correlations between selenoprotein and SeAlb concentrations in mothers and newborns, although they also showed significant differences in GPx-3 (11·2 (sd 3·7) v. 10·5 (sd 3·5) µg/l; P<0·01), SeP (42·5 (sd 9·5) v. 28·1 (sd 7·7) µg/l; P<0·01) and SeAlb (11·6 (sd 3·6) v. 14·1 (sd 4·3) µg/l; P<0·01) concentrations in maternal and cord sera, respectively. Serum GPx-3 activity and concentration were positively correlated in mothers (r 0·33; P=0·038) but not in newborns. GPx-3 activity in cord serum was significantly correlated with gestational age (r 0·44; P=0·009). SeAlb concentration was significantly higher in babies, whereas SeP and GPx-3 concentrations were significantly higher in mothers. The differences cannot be explained by simple diffusion; specific transfer mechanisms are probably involved. GPx-3 concentrations in mothers, at delivery, are related to maternal Se status, whereas the GPx-3 activity in cord serum depends on gestational age.

Bioactive Components in Human Milk Along the First Month of Life: Effects of Iodine Supplementation during Pregnancy.

BACKGROUND/AIMS: Human milk is considered the most suitable food for infants. The potential benefits of breastfeeding can be explained by the presence of different growth and neurotrophic factors in human milk. This study was designed to detect some biomarkers in human milk, which could be involved in the infant neurodevelopment and in the regulation of the maturation of neonatal intestine (brain-derived neurotrophic factor (BDNF), glial cell line-derived neurotrophic factor (GDNF), glial fibrillary acidic protein (GFAP), fibroblast growth factor 21 (FGF21), lysophosphatidic acid (LPA) and autotaxin (ATX)), and compare them on the basis of the consumption of iodine supplements or multivitamins. METHODS: A prospective study included 37 healthy breastfeeding mothers, divided into 3 different groups: (1) 10 mothers who did not take supplements, (2) 17 mothers who took potassium iodine (KI) 200 µg/day and (3) 10 mothers who took a multivitamin supplement. RESULTS: The concentrations of BDNF, GDNF, GFAP, FGF21, LPA and ATX in human milk were not significantly different in women who took a multivitamin or KI supplement compared with those who did not take any supplement. CONCLUSIONS: The presence of neurotrophic factors in human milk is neither modified by the consumption of supplements nor by their type.

Functional neuroimaging studies in asymmetric hearing loss.

This article presents an analysis of the impact of functional neuroimaging studies (positron emission tomography, PET) in asymmetric hearing loss based on the clinical expertise obtained from a group of 21 patients. In these patients, PET studies are performed at rest and after auditory stimulation in order to measure the increase in brain activity in the ipsi- and contralateral cortex, providing supporting evidence to recommend a specific treatment and the side to implant. In conclusion, PET is a useful tool for selected cases in which information on the metabolic status of the auditory pathway can drive the decision regarding the treatment of the most appropriate ear. However, in view of our small sample, further research is needed to confirm our results in this topic.

The application of cycling and cycling combined with feedback in the rehabilitation of stroke patients: a review.

Stroke is a leading cause of long-term disabilities, such as hemiparesis, inability to walk without assistance, and dependence of others in the activities of daily living. Motor function rehabilitation after stroke demands for methods oriented to the recovery of the walking capacity. Because of the similarities with walking, cycling leg exercise may present a solution to this problem. The aim of this article is to review the state of the art applications of cycling leg exercise as a (1) motor function rehabilitation method and an (2) aerobic training method for stroke patients as well as the commonly used (3) assessment tools. The cycling characteristics and applications, the applied test protocols as well as the tools used to assess the state and the recovery of patients and types of cycling devices are presented. In addition, the potential benefits of the use of other therapies, like feedback, together with cycling are explored. The application of cycling leg exercise alone and combined with feedback in stroke rehabilitation approaches has shown promising results. Positive effects on motor abilities were found in subacute and chronic patients. However, larger and normalized studies and assessments are needed because there is a high heterogeneity in the patients' characteristics, protocols and metrics. This wil allow the comparison between different studies related with cycling.

Epigenetic inactivation of the BRCA1 interactor SRBC and resistance to oxaliplatin in colorectal cancer.

BACKGROUND: A major problem in cancer chemotherapy is the existence of primary resistance and/or the acquisition of secondary resistance. Many cellular defects contribute to chemoresistance, but epigenetic changes can also be a cause. METHODS: A DNA methylation microarray was used to identify epigenetic differences in oxaliplatin-sensitive and -resistant colorectal cancer cells. The candidate gene SRBC was validated by single-locus DNA methylation and expression techniques. Transfection and short hairpin experiments were used to assess oxaliplatin sensitivity. Progression-free survival (PFS) and overall survival (OS) in metastasic colorectal cancer patients were explored with Kaplan-Meier and Cox regression analyses. All statistical tests were two-sided. RESULTS: We found that oxaliplatin resistance in colorectal cancer cells depends on the DNA methylation-associated inactivation of the BRCA1 interactor SRBC gene. SRBC overexpression or depletion gives rise to sensitivity or resistance to oxaliplatin, respectively. SRBC epigenetic inactivation occurred in primary tumors from a discovery cohort of colorectal cancer patients (29.8%; n = 39 of 131), where it predicted shorter PFS (hazard ratio [HR] = 1.83; 95% confidence interval [CI] = 1.15 to 2.92; log-rank P = .01), particularly in oxaliplatin-treated case subjects for which metastasis surgery was not indicated (HR = 1.96; 95% CI = 1.13 to 3.40; log-rank P = .01). In a validation cohort of unresectable colorectal tumors treated with oxaliplatin (n = 58), SRBC hypermethylation was also associated with shorter PFS (HR = 1.90; 95% CI = 1.01 to 3.60; log-rank P = .045). CONCLUSIONS: These results provide a basis for future clinical studies to validate SRBC hypermethylation as a predictive marker for oxaliplatin resistance in colorectal cancer.

Voltage-gated sodium channel polymorphisms play a pivotal role in the development of oxaliplatin-induced peripheral neurotoxicity: results from a prospective multicenter study.

BACKGROUND: The current prospective, multicenter study sought to identify single nucleotide polymorphisms of voltage-gated sodium channels (SCNAs) genes that might confer susceptibility to an increased incidence and severity of oxaliplatin-induced peripheral neuropathy (OXAIPN) in patients treated with either leucovorin, 5-fluorouracil, and oxaliplatin (FOLFOX) or oxaliplatin plus capecitabine (XELOX) for colorectal cancer (CRC). METHODS: A total of 200 patients with CRC were genotyped with real-time polymerase chain reaction using locked nucleic acid hydrolysis probes or allele-specific primers. All patients had received oxaliplatin-based chemotherapy, either in the adjuvant or metastatic setting. The incidence and severity of cumulative OXAIPN was graded using the clinical version of the Total Neuropathy Score and the neurosensory National Cancer Institute Common Toxicity Criteria (version 3.0). The incidence of acute OXAIPN was assessed using a descriptive questionnaire (yes/no response format) at each clinical evaluation. Acute OXAIPN was present in 169 of 200 patients (84.5%), whereas after treatment discontinuation, the cumulative/chronic form of neurotoxicity occurred in 145 of 200 patients (72.5%). RESULTS: In the logistic regression analysis adjusted for confounding factors, the overdominant model (CT vs CC + TT) of 2 single nucleotide polymorphisms (ie, SCN4A-rs2302237 and SCN10A-rs1263292) emerged as being significantly associated with an increased incidence of acute OXAIPN (rs2302237: odds ratio of 2.62 [95% confidence interval (95% CI), 1.15-6.00]; P = .019; and rs12632942: OR of 0.39 [95% CI, 0.17-0.88]; P = .023). However, only SCN4A-rs2302237 emerged as also being predictive of the clinical severity of acute OXAIPN (OR, 2.50 [95% CI, 1.35-4.63]; P = .0029) and the occurrence of cumulative/chronic OXAIPN (OR, 2.47 [95% CI, 1.04-5.85]; P = .037). CONCLUSIONS: The results of the current study provide evidence to support a causal relationship between SCNA polymorphisms and OXAIPN. However, further studies from independent groups are warranted to confirm these results.

Tratamento homeopático da enurese noturna em crianças: uma revisão bibliográfica / Homeopathic treatment of nocturnal enuresis in children: a literature review

Enurese noturna é definida como a eliminação involuntaria de urina durante o sono, pelo menos duas vezes por semana, pela criança em idade na qual o controle vesical ja deveria estar presente e sem anomalias congênitas adquiridas. O presente trabalho faz uma revisão bibliográfica a respeito de 9 medicamentos homeopáticos utilizados no tratamento da enurese noturna na criança. Ainda ressalta a Homeopatia como alternativa cínica no controle desta patologia. (AU)

In vitro dissolution profile of two commercially available iron preparations.

BACKGROUND: Current scientific evidence indicates that anemia in pregnancy, regardless of severity, is associated with an increased risk of maternal and fetal mortality. There is little published information about the bioavailability and bioequivalence of formulations containing both iron and folic acid. However, in vitro dissolution studies can provide important information on the likely relative bioavailability of various formulations. AIM: The objective of our study was to compare the in vitro dissolution of two similar commercially available formulations of iron- and folic acid-containing supplements, Folifer® (Bialport - Produtos Farmacêuticos, S.A., Portugal) and Ferroliver® (SM Pharma c.a., Venezuela), in order to determine the in vitro availability of their iron content. Folifer® and Ferroliver® were chosen because they contained similar amounts of elemental iron. METHODS: The amount of iron released from each tablet was evaluated over a 4-hour period in three dissolution media replicating gastric or intestinal juices with pH values ranging from 1.5 to 6.9. The samples were then titrated with a solution of cerium ammonium sulfate in order to calculate the amount of iron released in each specific pH condition. The percentage of dissolved iron was calculated as a cumulative frequency, using the percentage of dissolved iron at all timepoints. The dissolution similarity between the two commercially available formulations was evaluated using the &U0192;(2) statistic formula. RESULTS: During a 4-hour dissolution test, Folifer® released 59.4 mg of iron compared with 48.5 mg released by Ferroliver®. The value obtained for the similarity factor, an indicator of likely bioequivalence, was 41. CONCLUSION: These data suggest that Folifer® releases more iron than Ferroliver®, and that the two formulations are not equivalent in vitro. The superior dissolution of ferrous sulfate with Folifer® compared with ferrous fumarate in Ferroliver® might be responsible for the observed difference.

Field testing, gene flow assessment and pre-commercial studies on transgenic Solanum tuberosum spp. tuberosum (cv. Spunta) selected for PVY resistance in Argentina.

Solanum tuberosum ssp. tuberosum (cv. Spunta) was transformed with a chimeric transgene containing the Potato virus Y (PVY) coat protein (CP) sequence. Screening for PVY resistance under greenhouse conditions yielded over 100 independent candidate lines. Successive field testing of selected lines allowed the identification of two genetically stable PVY-resistant lines, SY230 and SY233, which were further evaluated in field trials at different potato-producing regions in Argentina. In total, more than 2,000 individuals from each line were tested along a 6-year period. While no or negligible PVY infection was observed in the transgenic lines, infection rates of control plants were consistently high and reached levels of up to 70-80%. Parallel field studies were performed in virus-free environments to assess the agronomical performance of the selected lines. Tubers collected from these assays exhibited agronomical traits and biochemical compositions indistinguishable from those of the non-transformed Spunta cultivar. In addition, an interspecific out-crossing trial to determine the magnitude of possible natural gene flow between transgenic line SY233 and its wild relative Solanum chacoense was performed. This trial yielded negative results, suggesting an extremely low probability for such an event to occur.

The presence of nuclear families in prehistoric collective burials revisited: the bronze age burial of Montanissell Cave (Spain) in the light of aDNA.

Ancient populations have commonly been thought to have lived in small groups where extreme endogamy was the norm. To contribute to this debate, a genetic analysis has been carried out on a collective burial with eight primary inhumations from Montanissell Cave in the Catalan pre-Pyrenees. Radiocarbon dating clearly placed the burial in the Bronze Age, around 3200 BP. The composition of the group-two adults (one male, one female), one young woman, and five children from both sexes-seemed to represent the structure of a typical nuclear family. The genetic evidence proves this assumption to be wrong. In fact, at least five out of the eight mitochondrial haplotypes were different, denying the possibility of a common maternal ancestor for all of them. Nevertheless, 50% of the inhumations shared haplogroup J, so the possibility of a maternal relationship cannot be ruled out. Actually, combining different analyses performed using ancient and living populations, the probability of having four related J individuals in Montanissell Cave would range from 0.9884 to 0.9999. Owing to the particularities of this singular collective burial (small number of bodies placed altogether in a hidden cave, the evidence of non-simultaneous interments, close dating and unusual grave goods), we suggest that it might represent a small group with a patrilocal mating system.

Revisão sistemática sobre tratamento tópico de lesões vegetantes malignas

Lesões vegetantes malignas (L VM) resultam da infiltração cutânea por células cancerígenas e, ao se exteriorizarem, adquirem aspecto vegetante. Odor fétido, exsudato profuso, sangramento, dor e infecção são sintomas comuns, que se somam ao sofrimento físico e psíquico destes pacientes. O cuidado de LVM insere-se na assistência aos pacientes em cuidados paliativos. OBJETIVOS: Caracterizar a produção científica sobre L VM e identificar evidências para o tratamento tópico do odor fétido de L VM. MÉTODOS: Trata-se de revisão sistemática. A questão clínica de pesquisa, construída utilizando-se a estratégia PICO, foi "Quais são os tratamentos tópicos/curativos utilizados para o controle dos sintomas odor, exsudato, sangramento, dor e/ou infecção das lesões vegetantes malignas?" A busca bibliográfica ocorreu em 09/2006 e utilizou 14 bases de dados: Banco de Teses - Capes, Biblioteca Digital de Teses e Dissertações - USP, Proquest, Current Controlled Trials, BDENF, CINAHL, Embase, PubMed, Ovid, Psyclnfo, Scopus, Web of Science, Lilacs e EBM Reviews. Não houve restrição quanto ao desenho de estudo e idioma. Os dados foram extraídos pelo pesquisador A, checados pelo B e decisões ocorreram em consenso. Pela análise dos resumos, foram incluídos estudos sobre L VM e que abordaram no mínimo 1 dos 5 sintomas investigados. Os estudos sobre odor foram analisados na íntegra e classificados quanto à qualidade do estudo, nível de evidência e grau de recomendação. RESULTADOS: Obteve-se 11.111 estudos, dos quais 325 (2.93%) referiam-se ao controle de algum dos sintomas das LVM por meio de intervenções tópicas: 12,37% relacionavam-se ao odor, 16,77% ao exsudato, 17,82% ao sangramento, 31,03% à dor e 22,01% à infecção de L VM; outros 202 estudos foram excluídos por não tratarem dos sintomas em análise. Entre os estudos (n=34) que analisaram o controle do odor, 5 foram ensaios clínicos (14,71 %), 20 revisões narrativas (58,82%), 5 séries de casos, 3 relatos de caso (8,82%) e 1 estudo de prevalência (2,94%). Foram identificados 16 tratamentos tópicos. Gel de Metronidazol tópico apresentou Evidência Forte para o controle do odor (grau A, nível 1C); Curativo de Carvão Ativado e Curativo de Mesalt, Evidência moderada (grau B, nível 2B); Pomada de Curcumin, Evidência Moderada (grau B, nível 2C). Evidência Fraca (grau C) e Muito Fraca (grau D) foram observadas em 12 tratamentos tópicos, que foram: Intervenções com Antibióticos tópicos, Chá verde, Enzimas tópicas, Hidrogéis, Iogurte, Mel, Óleos essenciais, Óleo essencial tópico (associado à Clorofila VO e Antibiótico sistêmico), Pasta de açúcar, Soluções anti-sépticas, Sulfadiazina de Prata e Trióxido de arsênico. A heterogeneidade das intervenções e a qualidade metodológica dos estudos não permitiram metanálise. CONCLUSÕES: Dos 11.111 estudos identificados, 2.93% (n=325) referiam-se aos sintomas em análise por meio de tratamentos tópicos. Dos 59 estudos sobre odor, 34 estudos atenderam a todos os critérios de inclusão. Encontraram-se...

Fungating malignant wounds (FMW) is the result of the cutaneous infiltration by cancerous cells and, when exteriorized, they acquire fungating aspect. Malodour, exudate, bleeding, pain and infection are common symptoms, wich are added to the psychological and physical suffering of these patients. The manage of FMW is inserted in the assistance of patients in palliative care. OBJECTNE: To characterize the scientific literature on FMW and to identify evidences for the topical therapy of malodour in FMW. METHODS: Systematic review. The clinical question of research, using the strategy PICO, was "Which are the topical/dressings therapy are used for the control of the malodour, exudate, bleeding, pain or infection of FMW? " The bibliographical search occurred in 09/2006 and it used 14 databases: Banco de Teses - Capes, Biblioteca Digital de Teses e Disserta~oes - USP, Proquest, Current Controlled Trials, BDENF, CINAHL, Embase, PubMed, Ovid, PsycInfo, Scopus, Web of Science, Lilacs and EBM Reviews. The data were extracted by reviewer A, checked by B and decisions were taken in consensus. By the analysis of the abstracts, studies about FMW that approached 1 of the 5 investigated symptoms were included. The studies about malodour were entirely analyzed and classified as regards the quality of the study, evidence level and recommendation degree. RESULTS: It was obtained 11.111 studies and of those, 325 (2.93%) referred to the control of some symptoms of FMW through of topical interventions: 12,37% related to the malodour, 16,77% to the exudate, 17,82% to the bleeding, 31,03% to the pain and 22,01 % to the infection of FMW; other 202 studies were excluded once they treat other symptoms. Among the studies (n=34) that analyzed the control of the malodour, 5 were clinical trials (14,71 %), 20 narrative reviews (58,82%), 5 series of cases, 3 case reports (8,82%) and 1 prevalence study (2,94%); they identified 16 topical treatments. Topical Metronidazole gel presented Strong Evidence for the control of the malodour (degree A, level 1 C); Activated Charcoal Dressing and Mesalt Dressing, moderate Evidence (degree B, level 2B); Ointment of Curcumin, Moderate Evidence (degree B, level 2C). Weak evidence (degree C) and Very Weak (degree D) were observed in 12 topical therapy, that were: Interventions with topical Antibiotics, green Tea, topical Enzymes, Hidrogels, Honey, Yogurt, essential Oils, topical essential Oil (associate to the Clorofila PO and systemic Antibiotic), Paste of sugar, antiseptic Solutions, Silver Sulfadiazine and Arsenic trioxide lotion. The heterogeneity of the interventions and the methodological quality of the studies didn't allow meta-analysis. CONCLUSIONS: Among of the 11.111 identified studies, 2.93% (n=325) they referred to the symptoms in analysis through topical...

An approach to evaluating drug-nutrient interactions.

Although the significance of interactions between drugs is widely appreciated, little attention has been given to interactions between drugs and nutrients. Pharmacists are challenged to remember documented interactions involving available drugs, and they face the possibility that each newly approved therapeutic agent may be involved not only in unrecognized drug-drug interactions but in drug-nutrient interactions as well. A more consistent approach to evaluating drug-nutrient interactions is needed. The approach must be systematic in order to assess the influence of nutritional status, food, or specific nutrients on a drug's pharmacokinetics and pharmacodynamics, as well as the influence of a drug on overall nutritional status or on the status of a specific nutrient. We provide such a process, using several recently approved drugs as working examples. Risk factors and clinical relevance are described, with distinctions made between documented and potential interactions. Application of this process by the pharmacist to any drug will help increase their expertise. Furthermore, full consideration by pharmacists of all possible interactions of the drug regimens used in practice can allow for improved patient care.