Edoxaban in cardiovascular disease management: Review.

In the past decade, direct oral anticoagulants (DOACs) have transformed the world of anti-thrombotic therapy. Edoxaban is the most recently approved DOAC. Though intended for use primarily in stroke prevention, it has found applications in various other conditions including thromboembolic and peripheral arterial disease. This review aims to provide a detailed outline of the growing indications, evidence for use in special populations, pharmacogenetics and side-effect profile of edoxaban.

Feasibility of Left Atrial Appendage Closure in Atrial Fibrillation Patients with a History of Intracranial Bleeding: A Systematic Review of Observational Studies.

BACKGROUND: Left atrial appendage occlusion (LAAO) is performed in patients with nonvalvular atrial fibrillation to reduce the risk of ischemic stroke. The patients with a history of intracranial hemorrhage were excluded from the pioneer randomized controlled trials. The purpose of this systemic review was to evaluate the data from observational studies reporting the efficacy and safety of LAAO in patients with a history of intracranial hemorrhage. METHODS: Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, Scopus, Global Index Medicus, and ClinicalTrials.gov data sources were utilized for data collection. RESULTS: A total of 12 studies met the inclusion criteria that included seven retrospective observational and five prospective observational studies. A total of seven hundred and twenty-seven patients with a history of intracranial hemorrhage underwent percutaneous left atrial appendage occlusion. There were 11 events of recurrent intracranial hemorrhage, 12 ischemic strokes, 4 transient ischemic attacks, and 26 all-cause deaths. The duration of follow-up varied from 3 months to 3.6 years in the included studies. CONCLUSION: Left atrial appendage occlusion can potentially be an effective and relatively safe treatment option to reduce the risk of ischemic stroke in selected patients with nonvalvular atrial fibrillation patients and history of intracranial hemorrhage. Future prospective randomized trials are needed to validate this approach.

Diagnostic and Management Dilemmas in Women Presenting with Acute Coronary Syndromes.

PURPOSE OF REVIEW: To summarize gender- and sex-specific differences in the presentation, diagnosis, management, and pathophysiology of women presenting with acute coronary syndrome (ACS). RECENT FINDINGS: Sex differences exist in many aspects of ACS that impact the identification, treatment, and outcomes in women. There are delays in the initiation of care, under recognized diagnostic differences based on sex, and inconsistencies in the management of ACS in women compared with men, that ultimately impact outcomes. Additionally, women with ACS are more likely than men to present with non-obstructive coronary artery disease (CAD), which appears to be due to diverse underlying pathophysiology. Women with ACS face diagnostic and treatment dilemmas from time of symptom onset to hospital discharge. Under-recognition, under-diagnosis, and under-treatment ultimately result in poorer outcomes in women. Underlying pathophysiologic differences in women require additional testing to elucidate underlying etiologies.

Adherence to treatment in Parkinson's disease: A multicenter exploratory study with patients from six Latin American countries.

BACKGROUND: Adherence to treatment in Parkinson's disease (PD) is compromised due to the need for multiple therapies, comorbidities related to aging, and the complexity of therapeutic schemes. In the present study, we aimed to explore adherence to treatment in groups of PD patients from six Latin-American (LA) countries and identify its associated demographic and clinical parameters. METHODS: A multicenter, cross-sectional, exploratory study was conducted from September 2016 to March 2017. Treatment adherence was assessed using the simplified medication adherence questionnaire (SMAQ), applied to patients and caregivers. Sociodemographic and clinical variables (MDS-UPDRS Part III-IV, MMSE, Beck Depression Inventory-II (BDI-II)) were recorded. RESULTS: Eight hundred patients from six LA countries were evaluated. Nonadherence was reported in 58.25% of the population, according to patients. The most frequent issues were forgetfulness and correct timing of doses. A high level of agreement in adherence prevalence and most SMAQ items were observed between patients and their caregivers. The nonadherent population had a significantly higher proportion of unemployment, free access to medication, troublesome dyskinesias and off-periods, lesser years of education, and worse motor, cognitive, and mood scores. In multiple logistic and linear regression analyses, MDS-UPDRS Part III, BDI-II, gender, free access to medication, treatment with dopamine agonists alone, years of education, excessive concerns about adverse effects, and beliefs about being well-treated remained significant contributors to adherence measures. CONCLUSION: Educational strategies, greater involvement of PD patients in decision-making, and consideration of their beliefs and values might be of great need to improve medication adherence in this PD population.

Use of complementary and alternative therapies in outpatients with Parkinson's disease in Argentina.

We interviewed 300 patients (54.7% male; mean age was 65.8 ± 9.5) attending the Movement Disorders Clinic at the Buenos Aires University Hospital to determine the prevalence of CATs use and their association with demographic, social, or disease-specific characteristics among patients with Parkinson's disease (PD) in Buenos Aires, Argentina. We found that 25.7% of the PD patients interviewed (77/300) stated they had used CATs to improve their PD symptoms whereas 38.0% (114/300) had used some CATs without any relation to PD, at least once in life. At the moment of the interview, CATs prevalence use was 50.6% in the former group and 25.0% in the latter. The use of CATs was much more frequent among women and more common in the 50- to 69-year age group. Friends and neighbors of the patients had most frequently recommended these therapies. No major association was observed between CATs use and the duration of the disease, side of initial involvement, PD phenotype, or the Hoehn and Yahr staging. Acupuncture, homeopathy, yoga, and therapeutic massage were the most widely used therapies. After the initiation of conventional treatment the use of massage, yoga, and acupuncture in patients using CATs to improve PD significantly increased. Neurologists should be aware and inquire about the use of CATs to rule out potentially harmful effects.

Esthesioneuroblastoma with widespread distant metastasis: Case report and literature review.

Esthesioneuroblastoma (ENB) is an uncommon sinonasal tract tumor, and it is even more uncommon among all neoplasms. Literature regarding the incidence and spread of the disease is limited. The prognosis of metastatic disease is poor. In this report, we present a case of recurrent ENB in a young woman involving metastasis to the neck, lungs, and ovary. Metastasis to the cervical lymph nodes is relatively common, but metastasis to the lungs is rare. Furthermore, to our knowledge, no cases of ovarian metastases of ENB have been reported. This case highlights the potential for widespread metastatic disease, suggesting the need for more frequent and thorough surveillance of patients diagnosed with recurrences of this tumor.

[Chronic disease and quality of life]. / Enfermedad crónica y calidad de vida.

UNLABELLED: Chronic diseases could produce functional limitations in different domains as well as depression and anxiety. Health related quality of life (HRQL) measures could help to identify functional problems not detected by clinical evaluations. Those measures could also help to better understand different group conditions and situations. Main objectives of this paper are: to study the presence of depressive and anxiety status in out patients with chronic diseases and to investigate its association with a better or worse HRQL in different domains. MATERIALS AND METHODS: This is a prevalence design study. Patients were recruited from an university Hospital. Consecutive samples were collected from three medical specialties: Chronic pain, Parkinson's disease and Mental Health. Social and demographic data were collected. The SF 36 was administered for the HRQL evaluation and the Hospital Anxiety and Depression (HADS) for screening anxiety and depression states. Descriptive statistics and the chi square test were used for data analysis. RESULTS: 630 out patients were included. 25% of patients with chronic pain, 15% of patients with Parkinson disease and 31% with a mental health condition were classified with a probably depression. In the three groups of patients depression was found to be associated with physical function and emotional role, from the SF 36's dimensions. In the mental health and in Parkinson's disease out patients'groups, anxiety was associated to the majority of SF 36's dimensions. CONCLUSIONS: Results showed the complexity of the health phenomena and the relevance that HRQL measures and population norms have for comparing different health profiles for giving support either to clinicians or to health services practices.

[Self-medication, the new silence epidemic. Studies in patients of clinical practice and mental health]. / La automedicación, una nueva epidemia silenciosa. Estudio en población de Salud Mental y Clínica Médica.

OBJECTIVE: The goal of this study is to describe magnitude and characteristics of self- medication in a psychiatric and clinical out-patients unit. METHOD: consecutive sample of 898 subjects (Mental Health 358 and Clinical Practice 540) at University Hospital, Buenos Aires, Argentina (2002). A questionnaire was administered by interviewers and was completed with information about social and demographics characteristics, physical and psychological health problems, and perception about doctors and patient relationships were collected. RESULTS: use of medication under prescription, 27.5%; without prescription, 60% (27.5% OTC and 31.9% automedication). The drugs more used in automedications were the psychotropics 59.8% (ansiolitics 88.8%) y antibiotics 9.4%. The 50% of the sample didn't consider automedication a risky behavior. Main reasons for beginning: 38.9% had had same problem previously treated by a doctor with that medication; and to alleviate symptomatic distress. No statistical significance was found related to age, sex, educational status. There was statistically significance associated with: less medical visits during last 12 months (p<0.01). Use of complementary therapies (p<0.0001), pain for more than 6 months (p<0.001), dissatisfaction with the manner in which the cause of the illness was investigated and how the diagnosis and treatment were informed to the patient (p<0.02). CONCLUSION: The automedication is dangerously installed and it's control is shared responsibility of doctors, patients, pharmaceutics and Public Health. The doctor must include the detection of abuse or misuse of psychotropics and assume the pedagogical task discussing the risk of autoprescription.

[Physician-patient relationship, scientific medicine and alternative therapies]. / La relación médico-paciente, la medicina científica y las terapias alternativas.

The objective of this paper is to describe the magnitude and characteristics of the use of complementary therapies in clinical practice. A consecutive sample of 540 outpatients who had sought medical care for the first time at the General Internal Medicine Program of a University Hospital were interviewed. A questionnaire was completed, collecting socio-demographic informations, data on physical and psychological health, perception of physician-patient relationship, self-medication, and beliefs associated with the disease and its treatment. Lifetime prevalence use of alternative therapies was near 55%. The most used were homeopathy and herbal medicines (40.8% and 37.6%, respectively). The evaluation of these practices was considered "excellent/very good/and good" 84.5% of the time. Significant associations were: females (p < 0.00001), high level of education (p < 0.001), dissatisfaction with the way in which the cause of the disease had been investigated and how the diagnosis and treatment had been communicated (p < 0.03), psychological and psychiatric treatment (p < 0.00001), self-medication (p < 0.0002), pain and concern during over 6 months due to disease or disability (p < 0.00001), lack of confidence in scientific medicine (p < 0.00001), the belief that "spiritual problems" (p < 0.00001), "mental conditions" (p < 0.003), and "emotional conditions" (p < 0.00001), popular beliefs, particularly daño & envidia (p < 0.00001), and mal de ojo (p < 0.001) have triggered the disease. One third of the patients attended the hospital while undergoing an alternative therapy that may pose an interference or interaction hazard. Emphasis is placed on the importance of medical education to assess physician-patient relationship and the ability to convey trust in medical procedures and treatments, and scientific consulting for other practices.

Gastrointestinal manifestations in Parkinson's disease: prevalence and occurrence before motor symptoms.

To assess the prevalence of gastrointestinal symptoms (GIS) in Parkinson's disease (PD) compared to control subjects and their timing of appearance in relationship to the onset of motor symptoms. There is a rostrocaudal gradient of alpha-synuclein (α-SYN) neuropathology in the enteric nervous system at early stages of PD with higher burden in the upper than the lower gut. However, only constipation has been recognized as a premotor gastrointestinal manifestation of PD. 129 PD patients and 120 controls underwent a structured questionnaire to assess the presence of GIS and, in PD patients, the time of their appearance respect to the onset of motor manifestations. GIS significantly more prevalent in PD patients were dry mouth, drooling, dysphagia, constipation and defecatory dysfunction. Constipation and defecatory dysfunction preceded motor manifestations. Whereas gastroparesis symptoms preceded motor manifestations, their prevalence was not significantly different from controls. Despite evidence of a higher α-SYN burden in the upper gut, only constipation and defecatory dysfunction were prominent premotor GIS of PD.

La relacion medico-paciente, la medicina cientifica y las terapias alternativas / Physician-patient relationship, scientific medicine and alternative therapies

The objective of this paper is to describe the magnitude and characteristics of the use of complementary therapies in clinical practice. A consecutive sample of 540 outpatients who had sought medical care for the first time at the General Internal Medicine Program of a University Hospital were interviewed. A questionnaire was completed, collecting socio-demographic informations, data on physical and psychological health, perception of physician-patient relationship, self-medication, and beliefs associated with the disease and its treatment. Lifetime prevalence use of alternative therapies was near 55%. The most used were homeopathy and herbal medicines (40.8% and 37.6%, respectively). The evaluation of these practices was considered "excellent/very good/and good" 84.5% of the time. Significant associations were: females (p < 0.00001), high level of education (p < 0.001), dissatisfaction with the way in which the cause of the disease had been investigated and how the diagnosis and treatment had been communicated (p < 0.03), psychological and psychiatric treatment (p < 0.00001), self-medication (p < 0.0002), pain and concern during over 6 months due to disease or disability (p < 0.00001), lack of confidence in scientific medicine (p < 0.00001), the belief that "spiritual problems" (p < 0.00001), "mental conditions" (p < 0.003), and "emotional conditions" (p < 0.00001), popular beliefs, particularly dano & envidia (p < 0.00001), and mal de ojo (p < 0.001) have triggered the disease. One third of the patients attended the hospital while undergoing an alternative therapy that may pose an interference or interaction hazard. Emphasis is placed on the importance of medical education to assess physician-patient relationship and the ability to convey trust in medical procedures and treatments, and scientific consulting for other practices

Calidad de vida en pacientes operados por cáncer del pulmón / Quality of life in patients operated of lung cancer

Antecedentes: Se ha señalado que la calidad de vida se deteriora luego de las resecciones pulmonares por cáncer del pulmón. Tal aseveración podría conducir a equivocaciones graves si llevara a negar la hasta hoy única posibilidad curativa en tales enfermos. Objetivos: Evaluar la calidad de vida relacionada con la salud (CVRS) en un grupo de enfermos operados por cáncer del pulmón. Lugar: División Cirugía Torácica, Hospital de Clínicas "José de San Martín", Universidad de Buenos Aires. Diseño: Retrospectivo, a través de encuestas específicas y escala visual numérica. Población: 74 enfermos operados por cáncer del pulmón entre 1989 y 2005. Método: Evaluación de estado de salud con más de 80 puntos en la escala visual (máximo 100). Sólo hubo correlación positiva con dolor en los primeros seis meses del postoperatorio. Se destacaron 18 y 12% de depresión y ansiedad probables, inadvertidas en los exámenes clínicos habituales. Conclusiones: La CVRS no se ve significativamente reducida luego de resecciones pulmonares por cáncer. Su evaluación es útil para mejorar el seguimiento y el cuidado postoperatorio.