ABSTRACT
A reabilitação de maxilas atróficas representa desafio complexo, levando à busca de abordagens inovadoras. Procedimentos convencionais, como levantamento de seio maxilar, têm limitações, impulsionando o interesse em implantes zigomáticos. Contudo, complicações persistem, especialmente em áreas de concavidade acentuada. Este relato de caso visa demonstrar a eficácia de uma abordagem cirúrgica inovadora, combinando implantes zigomáticos e transnasais, para superar as limitações anatômicas e alcançar resultados estéticos e funcionais satisfatórios. Paciente de 58 anos, sexo feminino, desdentada total, foi submetida à reabilitação no Instituto Rosenvaldo Moreira, devido à atrofia maxilar pronunciada. Foram propostos dois planos de tratamento, envolvendo implantes zigomáticos e transnasais. A cirurgia, realizada em ambiente ambulatorial sob sedação intravenosa e anestesia local, incluiu a instalação sequencial de implantes transnasais e zigomáticos, com especial atenção à usinagem do terço cervical para prevenir complicações. A abordagem cirúrgica empregada, combinando implantes zigomáticos e transnasais, revelou-se eficaz na reabilitação da maxila atrófica. A usinagem cuidadosa contribuiu para evitar complicações, evidenciando estabilidade e ausência de inflamações peri-implantares no acompanhamento de um ano. Este relato oferece uma contribuição valiosa, destacando a viabilidade e sucesso dessa abordagem inovadora em situações desafiadoras de atrofia maxilar na implantodontia.
The rehabilitation of atrophic jaws represents a complex challenge, leading to the search for innovative approaches. Conventional procedures, such as sinus lifts, have limitations, driving interest in zygomatic implants. However, complications persist, especially in areas of pronounced concavity. This case report aims to demonstrate the effectiveness of an innovative surgical approach, combining zygomatic and transnasal implants, to overcome anatomical limitations and achieve satisfactory aesthetic and functional results. A 58-year-old female patient, completely toothless, underwent rehabilitation at the Instituto Rosenvaldo Moreira, due to pronounced maxillary atrophy. Two treatment plans were proposed, involving zygomatic and transnasal implants. The surgery, performed in an outpatient setting under intravenous sedation and local anesthesia, included the sequential installation of transnasal and zygomatic implants, with special attention to machining the cervical third to prevent complications. The surgical approach used, combining zygomatic and transnasal implants, proved to be effective in the rehabilitation of the atrophic maxilla. Careful machining helped to avoid complications, demonstrating stability and absence of peri-implant inflammation in the one-year follow-up. This report offers a valuable contribution, highlighting the feasibility and success of this innovative approach in challenging situations of maxillary atrophy in implant dentistry.
Subject(s)
Humans , Female , Middle Aged , Rehabilitation , Atrophy , Osseointegration , Treatment Outcome , MaxillaABSTRACT
BACKGROUND: Previous studies have shown that women with coronary artery disease (CAD) are less likely to undergo angiography and have less favorable outcomes after percutaneous coronary intervention (PCI). OBJECTIVES: Assess the outcomes of women with acute coronary syndrome (ACS) and stable CAD (lesion>50%) treated with contemporary PCI using DES. METHODS: Observational, longitudinal cohort study with prospective follow-up included all female patients ≥ 18 years admitted at a tertiary public cardiovascular center in Brazil from January 2019 to December 2020. The level of significance adopted in the statistical analysis was 5%. RESULTS: 1146 women (average age 65 years) underwent guideline-recommended PCI. Risk factors were frequent (hypertension: 88%, dyslipidemia: 85%, diabetes: 47.5%), and 69% were admitted due to ACS. Radial access was used in 59% of patients; 1516 vessels were treated with 1725 stents implanted (1.5 stents/patient). PCI was successful in 97.7%, in-hospital death occurred in 1.2%, peri-procedural MI in 3.6%, and TIA in 0.4%. Predictors of in-hospital major adverse cardiac and cerebrovascular events (MACCE): previous stroke (OR: 2.97; CI: 1.06-7.15; p= 0.023), CKD (OR: 3.11; CI: 1.49-6.20; p= 0.002), and at least one procedural failure during PCI (OR: 10.2; CI: 1.17-5.9; p<0.001). The average follow-up was 576.2 days in 1047 patients. All-cause mortality occurred in 5.3%, cardiac death in 3.5%, recurrent ACS in 8%, and additional revascularization procedures in 5.5%. The predictors for MACCE during FU were hospital admission for ACS for the index PCI (OR: 1.58; HR: 1.06-2.35; p=0.023) and the presence of MACCE during hospitalization (OR: 6.66; HR: 2.42- 18.3; p< 0.001). CONCLUSION: In this pioneering study involving 1146 patients treated by contemporary PCI and followed for almost 2 years, we obtained very encouraging in-hospital and mid-term results.
FUNDAMENTO: Estudos prévios demonstram que mulheres com doença arterial coronariana (DAC) são menos submetidas a angiografia e apresentam resultados menos favoráveis após intervenção coronariana percutânea (ICP). OBJETIVOS: Avaliar os resultados de mulheres com síndrome coronariana aguda (SCA) e DAC estável (lesão>50%) tratadas com ICP contemporânea usando stents liberadores de drogas. MÉTODOS: Estudo de coorte observacional, longitudinal, com acompanhamento prospectivo, que incluiu todas as pacientes do sexo feminino > 18 anos admitidas em centro cardiológico público terciário no Brasil, no período de janeiro de 2019 a dezembro de 2020. RESULTADOS: 1146 mulheres (idade média de 65 anos) foram submetidas à ICP recomendada pela diretriz. Os fatores de risco foram frequentes (hipertensão: 88%, dislipidemia: 85%, diabetes: 47,5%) e 69% foram internadas devido à SCA. O acesso radial foi usado em 59% das pacientes; 1516 vasos foram tratados com 1725 stents implantados (1,5 stents/paciente). A ICP foi bem-sucedida em 97,7%, a morte intra-hospitalar ocorreu em 1,2%, IM periprocedimento em 3,6% e ataque isquêmico transitório em 0,4%. Preditores de eventos adversos cardíacos e cerebrovasculares maiores (ECCAM) intra-hospitalares: acidente vascular cerebral prévio (OR: 2,97; IC: 1,06-7,15; p = 0,023), DRC (OR: 3,11; IC: 1,49-6,20; p = 0,002) e pelo menos uma falha de procedimento durante ICP (OR: 10,2; IC: 1,17-5,9; p < 0,001). O acompanhamento médio foi de 576,2 dias em 1.047 pacientes. Mortalidade por todas as causas ocorreu em 5,3%, morte cardíaca em 3,5%, nova SCA em 8% e necessidade de nova revascularização em 5,5%. Os preditores de ECCM durante o seguimento foram admissão por SCA (retirar índice ICP) e a presença de ECCM durante a hospitalização (OR: 6,66; HR: 2,42-18,3; p< 0,001). CONCLUSÃO: Neste estudo pioneiro envolvendo 1146 pacientes tratados por ICP contemporânea e acompanhados por quase 2 anos, obtivemos resultados hospitalares e de médio prazo muito encorajadores.
Subject(s)
Coronary Artery Disease , Percutaneous Coronary Intervention , Humans , Female , Aged , Longitudinal Studies , Middle Aged , Coronary Artery Disease/surgery , Risk Factors , Treatment Outcome , Acute Coronary Syndrome/therapy , Acute Coronary Syndrome/surgery , Prospective Studies , Brazil , Practice Guidelines as Topic , Hospital Mortality , Drug-Eluting StentsABSTRACT
BACKGROUND: In patients with persistent atrial fibrillation (AF), addition of posterior wall isolation (PWI) to pulmonary vein isolation (PVI) is controversial. OBJECTIVE: Compare PVI plus PWI versus PVI alone in patients with persistent AF. METHODS: We searched PubMed (by MEDLINE), Embase, LILACS, CENTRAL (by Cochrane Library), and Clinicaltrials.gov databases for randomized trials comparing PVI + PWI and PVI alone in persistent AF. The outcomes were: (i) AF recurrence; (ii) composite of recurrent atrial arrhythmias (i.e., AF, atrial tachycardia, or atrial flutter); (iii) major clinical complications (i.e., pericardial effusion or tamponade, sinus node dysfunction, or atrioesophageal fistula); (iv) mean ablation time. Risk of bias and quality of evidence were evaluated using the Cochrane Risk of Bias 2.0 tool and GRADE, respectively. Statistical significance was set at 5%, and subgroup and sensitivity analyses were performed. RESULTS: We included eight studies and 1119 patients, of which 561 underwent PVI + PWI. During follow-up (12 - 24 months), recurrence of AF was significantly reduced with adjunctive PWI (RR 0.66, 95% CI 0.44-0.98). Composite of recurrent atrial arrhythmias did not differ significantly (RR 0.83, 95% CI 0.65-1.06). Major clinical complications (RR 0.81, 95% CI 0.42-1.58) were similar, with PVI alone having a shorter mean procedure time (mean difference -23.37 minutes, 95% CI -30.23, -16.50). CONCLUSION: Adjunctive PWI appears to be effective in improving recurrent AF, but not recurrence of all atrial arrhythmias. Procedure time was longer with PVI + PWI without significant change in overall safety. Further studies should focus on long-term benefit.
FUNDAMENTO: Em pacientes com fibrilação atrial (FA) persistente, a realização do isolamento da parede posterior (IPP) além do isolamento das veias pulmonares (IVP) é controversa. OBJETIVO: Comparar IVP mais IPP versus IVP exclusivo em pacientes com FA persistente. MÉTODOS: Trata-se de uma revisão sistemática conduzida nas bases de dados PubMed (MEDLINE), Embase, LILACS, CENTRAL (Cochrane Library), e Clinicaltrials.gov por ensaios clínicos randomizados comparando IVP + IPP e IVP exclusivo e FA persistente. Os desfechos foram (i) recorrência de FA; (ii) recorrência de arritmias atriais, isto é, FA, taquicardia atrial, ou flutter atrial); (iii) complicações clínicas importantes (isto é, derrame ou tamponamento pericárdico; disfunção do nó sinusal ou fístula atrioesofágica); (iv) tempo médio de ablação. O risco de viés e a qualidade da evidência foram avaliados usando a ferramenta Cochrane de avaliação de risco de viés (RoB 2.0) e o GRADE, respectivamente. A significância estatística foi estabelecida em 5%, e análises por subgrupos e de sensibilidade foram realizadas. RESULTADOS: Foram incluídos oito estudos e 1119 pacientes, dos quais 561 se submeteram a IVP+IPP. Durante o seguimento (12-24 meses), a recorrência de FA foi significativamente diminuída com IPP adjuvante (RR 0,66; IC 95%; 0,44-0,98). O composto de arritmias atriais recorrentes não difere significativamente (RR 0,83, IC 95% 0,65- 1,06). As complicações clínicas maiores (RR 0,81, IC95% 0,42-1,58) foram similares, e o IVP exclusivo foi associado a um tempo médio mais curto de procedimento (diferença média -23,37 minutos, IC 95% -30,23, -16,50). CONCLUSÃO: O IPP adjuvante parece efetivo em melhorar FA recorrente, mas não a recorrência de todas as arritmias atriais. O tempo de procedimento foi mais longo com IVP + IPP sem mudança significativa na segurança global. Mais estudos são necessários para investigar os benefícios em longo prazo.
Subject(s)
Atrial Fibrillation , Catheter Ablation , Pulmonary Veins , Recurrence , Humans , Atrial Fibrillation/surgery , Catheter Ablation/methods , Treatment Outcome , Pulmonary Veins/surgery , Randomized Controlled Trials as Topic , Time FactorsABSTRACT
INTRODUCTION: The CheckMate 816 study, a global phase III randomized trial, demonstrated that neoadjuvant treatment with nivolumab plus chemotherapy significantly improves event-free survival in patients with resectable non-small cell lung cancer (NSCLC). Additionally, the treatment significantly increases the rate of complete pathological response. We present the results of CheckMate 816 in an Argentine subpopulation to evaluate the efficacy and safety of the neoadjuvant treatment. MATERIALS AND METHODS: A retrospective observational and descriptive study was conducted at a high-volume single center in Argentina from January 2023 to March 2024. Patients received 360 mg of nivolumab plus chemotherapy and a platinum doublet every three weeks for three cycles before undergoing definitive surgery. The results were compared with the international trial and the Japanese population subgroup. RESULTS: Nine patients received neoadjuvant therapy, of whom eight underwent definitive surgery. All patients achieved complete (R0) resection, and in three cases, a complete pathological response was observed. Currently, all are alive and disease-free. DISCUSSION: The results obtained in the Argentine subpopulation were consistent with those observed in the global population and the Japanese subgroup. A high proportion of patients achieved a complete pathological response, an early indicator of therapeutic efficacy. Neoadjuvant therapy with nivolumab plus chemotherapy could be considered an effective treatment option for Argentine patients with resectable NSCLC.
Introducción: El estudio CheckMate 816, un ensayo global de fase III y aleatorizado, mostróque el tratamiento neoadyuvante con nivolumab más quimioterapia mejora significativamente la supervivencia libre de eventos y la tasa de respuesta patológica completa (RPC) en pacientes con cáncer de pulmón de células no pequeñas (CPCNP) resecable. Presentamos los resultados del CheckMate 816 en una subpoblación argentina para evaluar la eficacia y seguridad del tratamiento neoadyuvante. Materiales y métodos: Se realizóun estudio retrospectivo observacional y descriptivo en un único centro de alto volumen en Argentina en el periodo de enero 2023 hasta marzo 2024. Los pacientes recibieron 360 mg de nivolumab más quimioterapia con doblete de platino cada tres semanas durante tres ciclos, antes de someterse a cirugía definitiva. Se compararon los resultados con el ensayo internacional y el subgrupo de población japonesa. Resultados: Se reportóun total de nueve pacientes que recibieron neoadyuvancia de los cuales ocho fueron sometieron a cirugía definitiva. Todos alcanzaron una resección completa (R0) y en tres casos se logróuna RPC. Actualmente todos se encuentran vivos y libres de enfermedad. Discusión: Los resultados obtenidos en la subpoblación argentina fueron consistentes con los observados en la población global y en el subgrupo japonés. Una alta proporción de pacientes alcanzaron una RPC, indicador temprano de la eficacia terapéutica. El uso de neoadyuvancia con nivolumab más quimioterapia podría considerarse como una opción de tratamiento efectiva para pacientes argentinos con CPCNP resecable.
Subject(s)
Carcinoma, Non-Small-Cell Lung , Lung Neoplasms , Neoadjuvant Therapy , Nivolumab , Humans , Lung Neoplasms/therapy , Lung Neoplasms/drug therapy , Lung Neoplasms/pathology , Neoadjuvant Therapy/methods , Retrospective Studies , Carcinoma, Non-Small-Cell Lung/therapy , Carcinoma, Non-Small-Cell Lung/drug therapy , Carcinoma, Non-Small-Cell Lung/pathology , Argentina , Male , Female , Middle Aged , Aged , Nivolumab/therapeutic use , Treatment Outcome , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Immunotherapy/methodsABSTRACT
INTRODUCTION: Cranioencephalic traumatism (CET) is a serious public health problem worldwide. Advances in treatment have reduced mortality, increasing the demand for rehabilitation. The objective was to describe the demographic characteristics and functional outcomes in adult patients with traumatic brain injury (TBI) treated in a rehabilitation center. MATERIALS AND METHODS: Retrospective study between 2002 and 2022. Patients received 4 hours of rehabilitation daily. The level of functional independence was assessed with the Functional Independence Measure (FIM) at admission and discharge. RESULTS: 229 patients were included, the median (25-75 percentiles) time from injury to admission to rehabilitation was 56 (36-98) days; 76% were men. Mean age (standard deviation) 42 (17) years. The most frequent etiologies were car accidents and falls; 46.8% were under 40 years of age and the median length of stay was 82 days (14-132). At discharge, 79.9% of patients over 65 years of age had low to severe disability (GOS-E) and 79.5% returned home. The median (p 25-75) FIM at admission was 30 (20-55) and at discharge was 90 (58-106); a statistically significant difference was observed (p = 0.001). Differences in functional outcomes were found based on age and place of residence. DISCUSSION: In Argentina, patients admitted to rehabilitation for TBI are predominantly young men, the main cause being car accidents. The implementation of an early and intensive rehabilitation program has shown significant improvements in functional outcomes. At discharge, most patients required home supervision and assistance in daily activities.
Introducción: El traumatismo craneoencefálico (TCE) es un grave problema de salud pública a nivel global. Los avances en el tratamiento han reducido la mortalidad, incrementando la demanda en rehabilitación. El objetivo fue describir las características demográficas y resultados funcionales en pacientes adultos con lesión cerebral traumática (LCT) tratados en un centro de rehabilitación. Materiales y métodos: Estudio retrospectivo entre 2002 y 2022. Los pacientes recibieron 4 horas diarias de rehabilitación. El nivel de independencia funcional fue evaluado con la Medida de Independencia Funcional (FIM) al ingreso y al alta. Resultados: Se incluyeron 229 pacientes, la mediana (percentilos 25-75) del tiempo de lesión al ingreso a rehabilitación fue de 56 (36-98) días; 76% eran hombres. Edad media (desvío estándar) 42 (17) años. Las etiologías más frecuentes fueron accidentes automovilísticos y caídas; 46.8% tenía menos de 40 años y la mediana de estadía fue de 82 días (14-132). Al alta, el 79.9% de los pacientes mayores de 65 años presentaba discapacidad baja a grave (GOS-E) y el 79.5% regresóa su domicilio. La mediana (p 25-75) de FIM al ingreso fue 30 (20-55) y al alta fue 90 (58-106); observándose una diferencia estadísticamente significativa (p = 0.001). Se encontraron diferencias en los resultados funcionales entre la edad y lugar de residencia. Discusión: En Argentina los pacientes ingresados en rehabilitación por LCT son predominantemente hombres jóvenes, la causa principal son los accidentes automovilísticos. La implementación de un programa de rehabilitación temprano e intensivo ha demostrado mejoras significativas en los resultados funcionales. Al alta, la mayoría de los pacientes requirieron supervisión domiciliaria y asistencia en las actividades diarias.
Subject(s)
Brain Injuries, Traumatic , Recovery of Function , Rehabilitation Centers , Humans , Male , Female , Retrospective Studies , Argentina/epidemiology , Adult , Middle Aged , Rehabilitation Centers/statistics & numerical data , Brain Injuries, Traumatic/rehabilitation , Brain Injuries, Traumatic/mortality , Aged , Young Adult , Treatment Outcome , Disability Evaluation , Length of Stay/statistics & numerical data , AdolescentABSTRACT
OBJECTIVE: This study evaluated the effect of Stemregen® nutritional supplement on inflammation and resorption in apical periodontitis using a rat model. METHODOLOGY: Rats were divided in three groups: negative control (n=7), positive control (n=10), and Stemregen® (Stem) (n=10). Apical periodontitis was induced in the positive control and Stem groups, and all rats were sacrificed on the 30th day. Serum phosphorus (P), calcium (Ca), and alkaline phosphatase (ALP) were analyzed. Histopathological assessments measured osteoblastic and osteoclastic activity, inflammation, fibrosis, and abscess density. Immunohistochemical analyses evaluated RANKL, TRAP, and OPG levels. RESULTS: Results showed significantly lower osteoblastic activity in the negative control compared to Stem and positive control groups (p=0.005). Osteoclastic activity was higher in the positive control (p=0.032). Inflammation and abscess formation were reduced in the Stem group compared to the positive control (p<0.001). OPG levels were lower in the negative control compared to the other groups (p=0.005). CONCLUSION: Stemregen® effectively reduced inflammation and bone destruction, suggesting potential benefits for apical periodontitis management, though further research is needed.
Subject(s)
Alkaline Phosphatase , Disease Models, Animal , Osteoprotegerin , Periapical Periodontitis , Rats, Wistar , Animals , Periapical Periodontitis/therapy , Osteoprotegerin/analysis , Male , Alkaline Phosphatase/blood , Alkaline Phosphatase/analysis , Calcium/analysis , Calcium/blood , Phosphorus/blood , Phosphorus/analysis , Time Factors , Reproducibility of Results , Treatment Outcome , RANK Ligand/analysis , Immunohistochemistry , Osteoclasts/drug effects , Osteoblasts/drug effects , Random Allocation , Tartrate-Resistant Acid Phosphatase/analysis , Tartrate-Resistant Acid Phosphatase/blood , RatsABSTRACT
Introducción. La prueba de ventilación espontánea (PVE) en el proceso de liberación de la asistencia ventilatoria mecánica invasiva (AVMi) pediátrica es una práctica avalada; su positividad se sustenta en parámetros clínicos. Sin embargo, sus resultados están escasamente documentados. Objetivo. Describir los resultados de la PVE en el proceso de liberación de la AVMi. Población y métodos. Análisis retrospectivo. Pacientes con ≥ 48 h en AVMi del 1 de marzo de 2022 al 31 de enero de 2024. Resultados. Se analizaron 493 PVE en 304 pacientes; el 71 % (348) fueron positivas y el 87 % (302) redundó en extubaciones exitosas. Las causas de las PVE negativas fueron mayor trabajo respiratorio (70 %), frecuencia respiratoria (57 %) y frecuencia cardíaca (27 %). En el análisis univariado, la dificultad respiratoria como motivo de ingreso, la presión inspiratoria máxima previo a la PVE y el uso de tubo en T fueron predictores de PVE negativa. En el análisis multivariado, esta asociación persistió para el ingreso por causa respiratoria, la mayor frecuencia respiratoria programada en la AVM y la modalidad tubo en T. Quienes presentaron PVE negativas permanecieron más días en AVMi [9 (7-12) vs. 7 (4-10)] y en UCIP [11 (9-15) vs. 9 (7-12)]. Conclusión. La PVE positiva predijo la extubación exitosa en un alto porcentaje. La dificultad respiratoria al ingreso, la mayor frecuencia respiratoria programada y la mayor proporción de la modalidad tubo en T fueron predictores negativos para la prueba. La PVE negativa se asoció a mayor estadía en AVMi y UCIP.
Introduction. spontaneous breathing trial (SBT) in weaning from pediatric invasive mechanical ventilation (IMV) is an endorsed practice, its positivity is based on clinical parameters; however, its results could be better documented. Objective. To describe the results of the SBT in the IMV weaning process. Population and methods. Retrospective analysis. Patients with ≥48 h in IMV from March 1, 2022 to January 31, 2024. Results. A total of 493 SBT were analyzed in 304 patients; 71% (348) were positive, and 87% (302) resulted in successful extubations. The causes of negative SBT were increased work of breathing (70%), respiratory rate (57%), and heart rate (27%). In univariate analysis, respiratory distress as the reason for admission, peak inspiratory pressure before SBT and T-tube use, were predictors of negative SBT. In multivariate analysis, this association persisted for admission for respiratory cause, the higher programmed respiratory rate in IMV, as the T-tube modality. Those with negative SBT stayed more days in IMV (9 [712] vs. 7 [4-10]) and in PICU (11 [9-15] vs. 9 [7-12]). Conclusion. Positive SBT predicted successful extubation in a high percentage of cases. Respiratory distress on admission, higher programmed respiratory rate, and a higher proportion of T-tube mode were negative predictors of the test. Negative SBT was associated with more extended stays in IMV and PICU.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Respiration, Artificial/methods , Ventilator Weaning/methods , Respiration , Intensive Care Units, Pediatric , Work of Breathing/physiology , Retrospective Studies , Treatment Outcome , Respiratory Rate , Airway Extubation/methods , Length of StayABSTRACT
BACKGROUND: Dual sources of cells (DSC) with peripheral blood stem cell apheresis (PBSC) and surgical bone marrow (BM) for haploidentical hematopoietic cell transplantation (Hid-HCT) are used in China and some Asian countries. The experience of the Baltimore group for haploidentical transplant with post-transplant cyclophosphamide (PT-Cy) and reduced-intensity-conditioning (RIC) regimen used BM as a source of hematopoietic stem cells. METHODS: We retrospectively analyzed 64 Hid-HCT with DSC and PT-Cy, RIC (n = 57), or myeloablative-conditioning (MAC) (n = 7), from two public health Brazilian centers, with a median follow-up of 23.3 months (6.7-45.4). RESULTS: The 49 malignant patients were 27/46 (58.7%) beyond the first remission or with no complete response, and three patients did not complete disease status evaluation before transplant. Eight of 62 patients (12.9%) had grade 2 or more Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI), and two patients had no HCT-CI classified. Cytomegalovirus (CMV) viremia occurred in 26 of 57 (45.6%). The cumulative incidence of 100-day grade III-IV acute GVHD was 12.3% (7/57), with a 95% confidence interval (CI) of 3.8% and 20.8%, and 2-year moderate or severe chronic GVHD was 21.1% (11/52; 95% CI, 10.1%-32.3%). The 2-year relapses were 24.5% for malignant disease (12/49; 95% CI, 12.4%-36.5%). The 2-year overall survival (OS) probability was 54.7% (35/64; 95% CI, 42.5%-66.9%). Benign diseases achieve 2-year OS in 73.3% (11/15; 95% CI, 51%-95.7%) of the patients. The HCT-CI were significant in multivariate analyses for DFS (p = 0.002) and OS in uni- and multivariate analyses (both p < 0.001). The number of CD34+ cells by apheresis collection was significant in multivariate analysis for DFS (p = 0.039). CONCLUSION: Hid-HCT using PT-Cy, DSC, and RIC is a safe option for benign and malignant diseases.
Subject(s)
Cyclophosphamide , Graft vs Host Disease , Hematopoietic Stem Cell Transplantation , Transplantation Conditioning , Transplantation, Haploidentical , Humans , Male , Female , Adult , Middle Aged , Cyclophosphamide/therapeutic use , Hematopoietic Stem Cell Transplantation/methods , Hematopoietic Stem Cell Transplantation/adverse effects , Graft vs Host Disease/etiology , Young Adult , Retrospective Studies , Adolescent , Transplantation Conditioning/methods , Transplantation, Haploidentical/methods , Child , Treatment OutcomeABSTRACT
Background: Emerging evidence suggests that spirituality improves patient outcomes, however, this has undergone only limited evaluation in randomized trials. Hypertension is a major cause of cardiovascular morbidity and mortality worldwide. Objectives: To evaluate whether a spirituality-based intervention, compared to a control group, can reduce blood pressure (BP) and improve endothelial function after 12 weeks in patients with mild or moderate hypertension (HTN). Methods: Open randomized controlled trial of adults with stage I or II hypertension. Following baseline evaluation, including lifestyle questionnaires, and measurements of office and central blood pressure (BP), home blood pressure monitoring (HBPM) and flow mediated dilation (FMD), patients were randomized to a spirituality-based intervention, which included training for forgiveness, gratitude, optimism, and life purpose delivered by daily WhatsApp communications, or to the control group (CG). Main outcomes were between group difference in change from baseline to 12 weeks in office and central BP, HBPM and FMD, using t-tests, analyses of covariance (ANCOVA) adjusting for baseline differences, and, in addition, missing data imputation as a sensitivity analysis. Results: Fifty-one patients were randomized to spirituality-based intervention and 49 to control group. Baseline characteristics were well balanced between groups. Spirituality training, compared with control, improved 7.6 mmHg office systolic blood pressure (SBP), 4.1 mmHg central SBP and 4.1 percentage points FMD. Compared to control group, t-test demonstrated statistical significance for office SBP (-7.04 mmHg, p = 0.047) and FMD (7.46 percentage points, p < 0.001), and ANCOVA adjustment for baseline differences showed statistical significance for central SBP (-6.99 mmHg, p = 0.038) and FFMD (7.95 percentage points, p < 0.001) There was no significant effect on HBPM. Conclusion: A spirituality-based intervention was associated with improved control of office SBP and FMD. These findings will be prospectively evaluated in a nationwide larger and well-powered RCT.
Subject(s)
Blood Pressure , Hypertension , Spirituality , Humans , Male , Female , Hypertension/physiopathology , Hypertension/therapy , Hypertension/psychology , Middle Aged , Blood Pressure/physiology , Endothelium, Vascular/physiopathology , Endothelium, Vascular/physiology , Aged , Treatment Outcome , AdultABSTRACT
OBJECTIVE: To compare the effectiveness of ear acupuncture with laser and needles in the treatment of anxiety in university students in the post-pandemic context of Covid-19, as well as to evaluate the possible symptoms or adverse reactions triggered by the interventions. METHOD: Randomized clinical trial carried out with 126 university students, allocated to the "Needle" (control) and "Laser" (experimental) groups. Five ear acupuncture sessions were performed. Assessments were performed before, after the end of treatment and seven days later (follow up), through the State Anxiety Inventory and the measurement of heart and respiratory rates. The Generalized Estimating Equations were used. RESULTS: There was a reduction in anxiety levels in both groups, between the initial and final assessments, and initial and follow up. There was no difference between the groups in the final and follow up. Heart rate decreased in the Needle group between the final and follow up, and initial and follow up assessments; the Laser group remained constant over time and the groups did not differ from each other between the end and follow up. There was no change over time in respiratory rate in either group and they did not differ from each other in the final and follow up assessments. There was a higher occurrence of adverse reactions in the group that received the intervention with needles, despite the mild intensity. CONCLUSION: Both interventions were effective in reducing anxiety levels in university students. Brazilian Clinical Trials Registry RBR-8cxnvr2.
Subject(s)
Acupuncture, Ear , Anxiety , COVID-19 , Needles , Students , Humans , Female , Male , Anxiety/therapy , Anxiety/etiology , Young Adult , Acupuncture, Ear/methods , Students/psychology , Universities , Adult , Treatment Outcome , Laser Therapy/methods , Heart RateABSTRACT
INTRODUCTION AND HYPOTHESIS: Urinary incontinence (UI) is defined as any involuntary loss of urine and can be associated with urgency and/or physical exertion. Electrical stimulation (ES) has recently been identified as a proven therapeutic alternative for UI, with few side effects and low cost. This systematic review, registered on the Prospective Register of Systematic Reviews (RD42024528812), investigated whether home-based ES would be as viable as outpatient ES in the treatment of women with UI. METHODS: Study selection was conducted by two independent researchers across the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Web of Science, Scopus, and PEDro (search conducted on February 25, 2024). We also searched the reference lists of eligible articles. There were no restrictions on date and language. The RoB2 and GRADE tools were used to assess methodological quality and evidence recommendation. RESULTS: 723 articles were found, and four trials were eligible. Very low-quality evidence indicated statistically significant differences in cure rates or improvement of urinary symptoms in women treated with both outpatient and home-based ES. Low-quality evidence recommends home-based ES in maintaining improvement of urinary symptoms, and moderate-quality evidence indicates no severity of symptoms in the home-based group. CONCLUSION: Home-based ES is shown to be as effective as outpatient ES in the treatment of UI in women. However, data analysis revealed low-quality evidence regarding the cure or improvement of the women's conditions.
Subject(s)
Electric Stimulation Therapy , Urinary Incontinence , Humans , Female , Urinary Incontinence/therapy , Electric Stimulation Therapy/methods , Ambulatory Care/methods , Home Care Services , Outpatients/statistics & numerical data , Treatment OutcomeABSTRACT
Our objective was to assess the effect of Venous Leg Ulcer (VLU) healing on Quality of Life (QoL) in patients undergoing compression therapy. This non-randomized, quasi-experimental, and observational study involved patients with VLU. A convenience sample of individuals receiving services was followed for at least one year while undergoing compression therapy. The Medical Outcomes Short-Form Health Survey (SF-36) and the Charing Cross Venous Ulcer Questionnaire (CCVUQ) were employed to measure the variables of interest. Study participants were categorized into the Healed Group (HG) and the Unhealed Group (UG). The final sample comprised 103 individuals. The HG demonstrated improvements in SF-36 scores in the domains of Social Role Functioning (n = 34, p<0.001), Physical Role Functioning (n = 33, p<0.001), and the Physical Health Dimension (n = 38, p<0.001). Additionally, the CCVUQ assessment revealed score enhancements in the domains of Domestic Activities (n = 30, p = 0.001) and Social Interaction (n = 30, p = 0.009). QoL showed significant improvements in functionality, physical performance, and social interaction in the HG after one year of compression therapy treatment. In contrast, the UG was the only group to experience significant deteriorations in QoL.
Subject(s)
Quality of Life , Varicose Ulcer , Wound Healing , Humans , Female , Male , Middle Aged , Varicose Ulcer/therapy , Varicose Ulcer/psychology , Aged , Surveys and Questionnaires , Compression Bandages , Treatment OutcomeABSTRACT
PURPOSE: Investigations on identifying the nature of stuttering present varying views. The argument remains whether the stuttering dysfluencies have a motor or a linguistic foundation. Though stuttering is considered a speech-motor disorder, linguistic factors are increasingly reported to play a role in stuttering. Current literature points towards deficits in speech-related motor areas of the brain to abnormalities in linguistic planning and phonological memory playing a role in stuttering. Examining cross-linguistic generalization of treatment gains from treated to untreated language in bilinguals who stutter may provide a unique opportunity to explore the motor and linguistic factors in stuttering. METHODS: In the current study, we explored this potential by experimentally controlling the language of treatment in bilinguals with stuttering (BWS). We hypothesized that if the dysfluencies in stuttering arise from the underlying motor deficits, then the language of treatment would not play a significant role in cross-linguistic generalization. Sixteen BWS were given transcranial direct current stimulation (tDCS) along with behavioral intervention for three weeks. The language of treatment was randomized, wherein participants in one group received behavioral intervention in their dominant language and the other in their non-dominant language. RESULTS: Results showed that participants in both groups showed a reduction in their stuttering dysfluencies (% stuttered syllables) regardless of the language of treatment, and the treatment gains were generalized to the non-treated language. CONCLUSION: Linguistic factors such as language dominance and structure of languages did not surface to play a role in the generalization, signaling the motoric nature of dysfluencies in stuttering.
Subject(s)
Multilingualism , Stuttering , Humans , Stuttering/therapy , Stuttering/physiopathology , Male , Adult , Female , Young Adult , Transcranial Direct Current Stimulation/methods , Speech Therapy/methods , Adolescent , Treatment Outcome , Speech Production MeasurementABSTRACT
OBJECTIVE: Allergic rhinitis (AR) is highly prevalent worldwide. Good patient adherence ensures successful treatment. This study aimed to identify the association between the intranasal aerosol technique and symptom improvement. METHODS: This is an analytical, prospective, and longitudinal study that included 36 patients diagnosed with AR. The Rhinitis Control Assessment Test (RCAT) questionnaire was administered to both an experimental population and a control group. The 11 steps of the intranasal aerosol technique were explained to the experimental group, and performance was graded using a pamphlet for patient follow-up in subsequent controls. RESULTS: Of the participants, 63.9% were women and 36.1% were men, with a median age of 30 years (IQR 24-42) and an age range from 18 to 69 years. An average RCAT percentage of 55.6% was observed in both groups during the first consultation. On the second visit, a difference in disease control was noted. In the experimental group, 83.3% had controlled symptoms, whereas only 61.1% of the control group did. At the third visit, 76.5% of the experimental group had controlled symptoms, compared to 58.8% of the control group. In the experimental group, 52.9% of patients demonstrated good technique, while only 5.9% in the control group did (p=0.004). CONCLUSIONS: Patient education and training, compared to an untrained group, benefit the patient by aiding in the remission of symptoms and improving quality of life.
Subject(s)
Administration, Intranasal , Rhinitis, Allergic , Humans , Female , Male , Adult , Middle Aged , Rhinitis, Allergic/diagnosis , Young Adult , Adolescent , Prospective Studies , Aged , Longitudinal Studies , Surveys and Questionnaires , Nasal Sprays , Aerosols , Treatment OutcomeABSTRACT
BACKGROUND: Physicians worldwide face the challenging task of improving patient satisfaction by reducing pain in injured patients. Currently, available therapeutic approaches provide only short-term relief of symptoms without addressing long-term satisfaction. This has led to exploring regenerative treatment options that can deliver better outcomes. One such promising option is platelet-rich plasma (PRP) injections, which are gaining popularity as an alternative to standard steroid injections. OBJECTIVES: This study examines the therapeutic effects of PRP injections in adult patients with stress or traumatic injuries. METHODS: The systematic literature review yielded 60,301 articles, books, and websites verified and removed from the final project. The final studies used in the report comprised randomized trials, observational studies, and case reports on injecting biologics into the epidural space, facet joints, or sacroiliac joints. In total, 15 reviews and 13 studies were included in this review. RESULTS: In the Wu et al study, 46 participants were randomly divided into group A (0.5 mL PRP injection) and group B (1.5 mL methylprednisolone injection). Although group B initially showed a notable pain reduction at one week, it diminished over 6 months, with group A consistently improving, reaching an 80.96% success rate and higher patient satisfaction. In the study by Singla et al comparing PRP (group P) and corticosteroid (group S) in 40 participants, PRP demonstrated a markedly greater reduction in VAS Scale at 6 weeks and 3 months, with a 90% effectiveness compared with 75% for steroids. CONCLUSION: PRP injections offer greater pain alleviation, disability reduction, and overall patient satisfaction improvements due to their effect on the immune response to promote the growth and proliferation of damaged tissue. It has also been shown to offer a safer alternative that carries fewer risks than that of transforaminal steroid injections due to promising clinical trials and scientific investigation outcomes. Several of the steroid injection studies proved to have mixed results and efficacy because patients reporting having similar pain relief with placebo groups that used saline injections. Further studies will be needed to evaluate PRP's long-term efficacy and cost-effectiveness for practical patient use in the future.
Subject(s)
Platelet-Rich Plasma , Zygapophyseal Joint , Humans , Injections, Intra-Articular , Treatment OutcomeABSTRACT
Basal ganglia hemorrhage (BGH) is a prevalent site for intracerebral hemorrhage. Although neuroendoscopy (NE) surgery has emerged as a less invasive alternative to craniotomy (CT), the optimal surgical method remains debatable. This systematic review and meta-analysis aimed to compare the efficacy and safety of NE versus CT in the management of BGH. A systematic search of PubMed, Embase, Cochrane Library, and Web of Science databases was conducted to identify eligible randomized controlled trials (RCTs) comparing NE surgery with CT in BGH patients. Outcomes included mortality, hematoma evacuation rate, good functional outcome (GFO), operative time, infection, pulmonary infection, and postoperative complication. Risk of bias was assessed with Cochrane's ROB-2 tool. Four RCTs were included, comprising 423 patients. NE surgery showed no significant benefit in mortality (p = 0.12) and GFO (p = 0.18). However, NE was associated with a higher hematoma evacuation rate (p = 0.007), shorter operative time (p < 0.00001), and lower rates of infection (p < 0.0001), pulmonary infection (p < 0.0001), and postoperative complications (p < 0.00001). Future research should be designed to assess whether hematoma evacuation using either technique improves outcomes in comparison to optimal medical management in this population.
Subject(s)
Basal Ganglia Hemorrhage , Craniotomy , Neuroendoscopy , Randomized Controlled Trials as Topic , Humans , Craniotomy/methods , Neuroendoscopy/methods , Basal Ganglia Hemorrhage/surgery , Postoperative Complications/epidemiology , Treatment OutcomeABSTRACT
OBJECTIVE: To assess the outcomes of three surgical techniques in the management of simple gastroschisis. MATERIALS AND METHODS: An observational, descriptive, retrospective, longitudinal study was carried out. Medical records of patients diagnosed with simple gastroschisis and treated with different surgical techniques -Simil-Exit, primary closure, and deferred closure- were reviewed. RESULTS: 38 gastroschisis patients undergoing either the Simil-Exit (n= 10), the primary closure (n= 11), or the deferred closure (n= 17) techniques were analyzed. The Simil-Exit technique involved a shorter operating time than primary closure and deferred closure. Both Simil-Exit and primary closure patients required a shorter mechanical ventilation time, fewer days of parenteral nutrition, shorter time to oral feeding initiation, and a shorter hospital stay than deferred closure patients. The deferred closure technique had more frequent complications, such as sepsis. CONCLUSIONS: The Simil-Exit and the primary closure techniques demonstrated favorable outcomes in patients with simple gastroschisis. In addition, the former involved shorter operating times, it required less exposure of the small bowel loops to the environment, it was easily reproducible, and it provided a better cosmetic result.
OBJETIVOS: Evaluar los resultados de tres técnicas quirúrgicas para la resolución de gastrosquisis simple. MATERIAL Y METODOS: Se realizó un estudio observacional, descriptivo, retrospectivo y longitudinal. Fueron revisados los expedientes clínicos de pacientes con diagnóstico de gastrosquisis simple tratados con diferentes técnicas quirúrgicas, Símil-Exit, cierre de pared primario y cierre de pared diferido. RESULTADOS: Se analizaron los datos de 38 pacientes con gastrosquisis que fueron intervenidos quirúrgicamente con técnica Símil-Exit (n= 10), con cierre de pared primario (n= 11) y con cierre de pared diferido (n= 17). La técnica Símil-Exit mostró menor tiempo quirúrgico que el cierre de pared primario y que el cierre de pared diferido; tanto los pacientes intervenidos con Símil Exit como los de cierre de pared primario, con respecto a los de cierre de pared diferido, requirieron menor tiempo de ventilación mecánica, menor número de días de apoyo con nutrición parenteral, menor intervalo de tiempo para el inicio de alimentación oral y menor tiempo de estancia hospitalaria. La técnica de cierre diferido de pared presentó con mayor frecuencia complicaciones como sepsis. CONCLUSIONES: La técnica Símil-Exit y el cierre de pared primario mostraron resultados favorables en pacientes con gastrosquisis simple; la primera, además, requirió de menor tiempo quirúrgico, menor exposición de asas intestinales al medio ambiente, fácilmente reproducible y mejor resultado estético.
Subject(s)
Gastroschisis , Length of Stay , Gastroschisis/surgery , Humans , Retrospective Studies , Female , Male , Infant, Newborn , Treatment Outcome , Length of Stay/statistics & numerical data , Longitudinal Studies , Operative Time , Respiration, Artificial/statistics & numerical data , Parenteral Nutrition/methodsABSTRACT
To evaluate the incidence of mortality, hemorrhage, and neurological deficits in treating intracranial arteriovenous malformations (AVMs) in patients over 18 through a comparative analysis of surgical approaches and other therapeutic modalities. A systematic review was conducted using MEDLINE, Embase, CENTRAL, and LILACS databases in November 2023. Inclusion criteria included clinical trials, cohorts studies, case-controls studies, and case series comparing patients over 18 undergoing surgery or microsurgery versus other treatments (radiosurgery, isolated embolization, and conservative treatment). Exclusions criteria included studies on non-AVM diseases, non-intracranial AVMs, cavernous malformations, pregnant patients, and those treated with both radiosurgery and microsurgery. Twelve studies included 1,555 patients, with an average age of 42.65 years. Of these, 711 underwent surgery (with or without prior embolization), and 844 underwent other procedures. In the surgery group, the incidence of death was 1.69%, while in the other procedures group, it was 2.96%. The incidence of neurological deficits and hemorrhage in the surgery group was 11.67% and 4.22%, respectively. In other procedures, these incidences were both 9.12%. The average obliteration rate in the surgery group was 97.45%, compared to 49.77% for radiosurgery, 38.46% for isolated embolization, and 0.6% for conservative treatment. This systematic review highlighs that surgery achieves the highest AVM obliteration rates but carries a higher risk neurological déficits. Radiosurgery minimizes these risks, while conservative treatment offers advantages in mortality and hemorrhage reduction. No single modality proves to be universally superior, emphasizing the need for personalized approaches and further randomized trials to clarify comparative safety and efficacy.
Subject(s)
Embolization, Therapeutic , Intracranial Arteriovenous Malformations , Radiosurgery , Humans , Intracranial Arteriovenous Malformations/surgery , Intracranial Arteriovenous Malformations/therapy , Intracranial Arteriovenous Malformations/complications , Radiosurgery/methods , Incidence , Embolization, Therapeutic/methods , Neurosurgical Procedures/methods , Microsurgery/methods , Treatment OutcomeABSTRACT
Objectives: We conducted a systematic review to compile the findings of all published studies on the use of percutaneous laser ablation (PLA) in the treatment of early-stage breast cancer. We aimed to identify appropriate methodology as well as parameters for the selection of suitable patients to optimize outcomes with the use of PLA. Additionally, we aimed to analyze whether this method is a viable alternative to current surgical treatments employed. Methods: The PRISMA 2020 method was applied. The terms "laser ablation" AND "breast cancer" were used to select all articles published up to January 2024 on the PubMed and Embase platforms. Articles in English were included. Only original articles were considered for this systematic review. Review articles, editorials, letters, and studies ex-vivo or not performed in humans were excluded. Results: Seventeen articles, including 308 patients were analyzed. Among the studies describing the complete response rate to assess treatment success, there was no residual tumor after ablation in 74.4% of the patients. MRI was the best exam to evaluate the effectiveness of the ablative procedure with a NPV of 92% to 100%. Skin burn was the most commonly observed complication, occurring in 6% of patients. Other less frequent complications were hematoma/bleeding, pain, nodulation, erythema, seroma, and fat necrosis. Conclusions: The use of PLA remains restricted to cases with specific indications or within the context of research protocols. However, future studies may validate this promising technique for the local treatment of early-stage breast cancer. This study was registered at INPLASY (registration number: INPLASY2024100045).
Subject(s)
Breast Neoplasms , Laser Therapy , Humans , Breast Neoplasms/surgery , Breast Neoplasms/pathology , Female , Laser Therapy/methods , Treatment Outcome , Neoplasm StagingABSTRACT
The mini-pterional craniotomy (mPT) was designed to be a minimally invasive alternative to the standard pterional (PT) approach. However, it remains unclear which technique produces better results. Thus, we aimed to perform a meta-analysis comparing functional, surgical, and aesthetic outcomes between mPT and PT in intracranial aneurysms. We searched PubMed, EMBASE, Web of Science, and Cochrane Library for studies comparing mPT to PT in patients who underwent clipping of brain aneurysms until June 2024. Outcomes were modified Rankin Scale (mRS) or Glasgow Outcome Scale (GOS), surgical complications, operation time, length of stay, and patients' aesthetic satisfaction. Statistical analysis was performed using the R software (version 4.4.0). Heterogeneity was assessed with I2 statistics. We included 6 studies with a total of 1011 patients, of whom 696 (63.1%) underwent mPT. The mean age was 59.0 ± 2.8 years, 67.6% were female, and 68.2% of all aneurysms were located in the middle cerebral artery. Unfavorable functional outcome (mRS ≥ 3 or GOS ≤ 3) at discharge (OR 0.21, 95% CI: 0.07-0.59; I2 = 0%), overall surgical complications (OR 0.45, 95% CI: 0.21-0.99; I2 = 72%), and operation time (MD - 54.42 min, 95% CI: -60.78 to - 48.06; I2 = 0%) were significantly lower in mPT compared to PT. Moreover, patients' aesthetic satisfaction was statistically higher in mPT (OR 2.91, 95% CI: 1.06-8.00; I2 = 0%). However, there was no significant difference in length of stay between groups (MD - 1.52 days, 95% CI: -3.75 to 0.72; I2 = 72%). Mini-pterional craniotomy is associated with better functional outcomes at discharge, fewer surgical complications, and a shorter operation time. Therefore, our results might suggest that mPT is a promising and preferable alternative to standard PT.