RESUMEN
Despite advances in the treatment of Alzheimer's disease (AD), there is currently no prospect of a cure, and evidence shows that multifactorial interventions can benefit patients. A promising therapeutic alternative is the use of transcranial direct current stimulation (tDCS) simultaneously with cognitive intervention. The combination of these non-pharmacological techniques is apparently a safe and accessible approach. This study protocol aims to compare the efficacy of tDCS and cognitive intervention in a double-blind, randomized and factorial clinical trial. One hundred participants diagnosed with mild-stage AD will be randomized to receive both tDCS and cognitive intervention, tDCS, cognitive intervention, or placebo. The treatment will last 8 weeks, with a 12-month follow-up. The primary outcome will be the improvement of global cognitive functions, evaluated by the AD Assessment Scale, cognitive subscale (ADAS-Cog). The secondary outcomes will include measures of functional, affective, and behavioral components, as well as a neurophysiological marker (Brain-derived neurotrophic factor, BDNF). This study will enable us to assess, both in the short and long term, whether tDCS is more effective than the placebo and to examine the effects of combined therapy (tDCS and cognitive intervention) and isolated treatments (tDCS vs. cognitive intervention) on patients with AD. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02772185-May 5, 2016.
RESUMEN
Care for elderly patients undergoing orthopedic surgery, particularly for those requiring emergency surgery, needs to take into account an analysis of physical capacity and risks specific to elderly individuals, in an attempt to reduce the risks. Nevertheless, these remain high in this group. Despite the risks, procedures developed promptly have a positive effect on these patients' evolution. Coordinated care, composed of teams of specialists within clinical medicine, geriatrics, orthopedics, anesthesiology and critical care, along with other healthcare professionals, may be highly beneficial for this group of patients.
RESUMEN
A atenção a pacientes idosos submetidos à cirurgia ortopédica, particularmente os que necessitam de cirurgia de urgência, deve levar em conta a análise da capacidade física e de riscos específicos dos indivíduos idosos, na tentativa de reduzir riscos que, no entanto, permanecem elevados neste grupo. Apesar dos riscos, procedimentos desenvolvidos com prontidão têm efeito positivo na evolução destes pacientes. A atenção coordenada integrada por equipe clínica/geriátrica, ortopédica, anestésica, intensivistas e demais profissionais de saúde pode ser altamente benéfica neste grupo de pacientes.
Care for elderly patients undergoing orthopedic surgery, particularly for those requiring emergency surgery, needs to take into account an analysis of physical capacity and risks specific to elderly individuals, in an attempt to reduce the risks. Nevertheless, these remain high in this group. Despite the risks, procedures developed promptly have a positive effect on these patients' evolution. Coordinated care, composed of teams of specialists within clinical medicine, geriatrics, orthopedics, anesthesiology and critical care, along with other healthcare professionals, may be highly beneficial for this group of patients.
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Medicina de Emergencia , Procedimientos Ortopédicos , Asunción de Riesgos , Signos y SíntomasRESUMEN
O objetivo deste estudo foi investigar a interferência dos óleos essenciais de Lippia sidoides Cham, Plectranthus amboinicus Lour Spr., Conyza bonariensis L. e Eucalyptus citriodora Hook sobre o efeito de antibióticos utilizados na clínica. Os ensaios foram realizados com ampicilina (10 µg/mL), cefalotina (30 µg/mL), cloranfenicol (30 µg/mL), gentamicina (10 µg/mL) e tetraciclina (30 µg/mL) isolados e em associação com os óleos essenciais (4 por cento v/v) através do método de difusão em meio sólido utilizando discos de papel de filtro. Os resultados mostraram interferência de alguns óleos essenciais sobre a atividade dos antibióticos ensaiados. Observou-se o desenvolvimento de halos de inibição do crescimento bacteriano com diferentes diâmetros quando da aplicação de antibióticos isolados e em combinação com os óleos essenciais. A ocorrência de comportamento sinérgico ou antagônico foi observada mais proeminentemente nas interações com cepas de S. aureus e S. epidermidis. De outra forma, observou-se uma menor interferência dos óleos essenciais no efeito dos antibióticos sobre as cepas Gram negativas, principalmente P. aeruginosa. Estes resultados mostram que o uso de produtos derivados de plantas pode em algumas situações interferir sobre a efetividade de antibióticos de uso no tratamento clínico.
The aim of this study was to evaluate the interference of essential oils from Lippia sidoides Cham, Plectranthus amboinicus Lour Spr., Conyza bonariensis L. and Eucalyptus citriodora Hook on the antibacterial effect of clinically used antibiotics. The assays were carried out with ampicillin (10 µg/mL), cephalotin (30 µg/mL), chloraphenicol (30 µg/mL), gentamicin (10 µg/mL) and tetracyclin (30 µg/mL) isolated and associated with essential oils (4 percent v/v) by the solid medium diffusion procedure using filter paper discs. The results showed interference of some essential oils on the antibacterial activity of the assayed antibiotics. It was observed the development of growth inhibition halo with different diameters when the antibiotics were applied alone and associated with essential oils. Synergic or antagonic behavior was more prominent in interactions with S. aureus and S. epidermidis strains. On the other hand, it was observed a smaller interference of essential oils on the effect of the antibiotics against Gram negative strains, mainly P. aeruginosa. These results show that the use of plants by-products could some times interfere on the effectiveness of antibiotics used clinically.
