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1.
Mult Scler Relat Disord ; 41: 102034, 2020 Mar 03.
Artículo en Inglés | MEDLINE | ID: mdl-32200337

RESUMEN

BACKGROUND: Multiple sclerosis is a progressive disease responsible for gait disabilities and cognitive impairment, which affect functional performance. Robot-assisted gait training is an emerging training method to facilitate body-weight-supported treadmill training in many neurologic diseases. Through this study, we aimed to determine the efficacy of robot-assisted gait training in patients with multiple sclerosis. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials evaluating the effect of robot-assisted gait training for multiple sclerosis. We searched PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov registry for articles published before May 2019. The primary outcome was walking performance (gait parameters, balance, and ambulation capability). The secondary outcomes were changes in perceived fatigue, severity of spasticity, global mobility, physical and mental quality of life, severity of pain, activities of daily living, and treatment acceptance. RESULTS: We identified 10 studies (9 different trials) that included patients with multiple sclerosis undergoing robot-assisted gait training or conventional walk training. The meta-analysis showed comparable effectiveness between robot-assisted gait training and conventional walking therapy in walking performance, quality of life, pain, or activities of daily living. The robot-assisted gait training was even statistically superior to conventional walking therapy in improving perceived fatigue (pooled SMD: 0.34, 95% CI: 0.02-0.67), spasticity (pooled SMD: 0.70, 95% CI: 0.08-1.33, I² = 53%), and global mobility (borderline) after the intervention. CONCLUSION: Our results provide the most up-to-date evidence regarding the robot-assisted gait training on multiple sclerosis. In addition to the safety and good tolerance, its efficacy on multiple sclerosis is comparable to that of conventional walking training and is even superior in improving fatigue and spasticity.

2.
Medicine (Baltimore) ; 99(2): e18741, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914092

RESUMEN

Inappropriate care for patients with cognitive dysfunction in the hospital could worsen quality of care and medical service satisfaction.All elderly participants were recruited from acute wards of 5 departments in an university hospital. They were administered the Chinese version of Ascertain Dementia 8 (AD8) at admission and the Nursing Service Satisfaction Questionnaire before discharge.A total of 345 participants completed the study. There were 91 (26.4%) participants with AD8 ≥ 2, the cut-off value of high risk of dementia. The prevalence was much higher than prior community-based reports. The Nursing Service Satisfaction Score was significantly lower in AD8 ≥ 2 than in AD8 < 2 (56.99 ±â€Š0.94 vs 60.55 ±â€Š0.48, P < .01).Using AD8 in hospital-based screening might be more efficient than in the community in terms of cost-effectiveness due to higher positive rate and easier approach to diagnostic facilities. AD8 ≥ 2 is also an indicator to identify care dissatisfaction among inpatients. By identifying patients with cognitive dysfunction, such as its related communication barriers, care systems could be tailored for more friendly services.


Asunto(s)
Demencia/diagnóstico , Demencia/enfermería , Tamizaje Masivo/métodos , Satisfacción del Paciente , Encuestas y Cuestionarios/normas , Anciano , Anciano de 80 o más Años , Análisis Costo-Beneficio , Demencia/epidemiología , Femenino , Humanos , Masculino , Tamizaje Masivo/economía , Tamizaje Masivo/normas , Persona de Mediana Edad , Calidad de la Atención de Salud/normas , Reproducibilidad de los Resultados
3.
Cancers (Basel) ; 11(10)2019 Sep 29.
Artículo en Inglés | MEDLINE | ID: mdl-31569587

RESUMEN

Background: The effect of clopidogrel, whose mechanism of action differs from that of aspirin, on CRC risk remains unknown. We investigated the effects of clopidogrel and aspirin, either as monotherapy or combined, on colorectal cancer (CRC) risk in patients with Type 2 diabetes mellitus (T2DM). Methods: We conducted a cohort study using Taiwan National Health Insurance Research Database. Four groups comprising 218,903 patients using aspirin monotherapy, 20,158 patients using clopidogrel monotherapy, 42,779 patients using dual antiplatelet therapy, and 281,840 nonuser matched controls were created using propensity score matching. Cox proportional hazards regression was used to evaluate the CRC risk during follow-up. Results: During the 13-year follow-up period, we found 9431 cases of CRC over 3,409,522 person-years. The overall incidence rates of CRC were 2.04, 3.45, 1.55, and 3.52 per 1000 person-years in the aspirin, clopidogrel, dual antiplatelet, and nonuser cohorts, respectively. The adjusted hazard ratios (aHRs) were 0.59 (95% confidence interval [CI], 0.56-0.61), 0.77 (95% CI, 0.68-0.87), and 0.37 (95% CI, 0.33-0.40) for the aspirin, clopidogrel, and dual antiplatelet cohorts, respectively. Dose- and duration-dependent chemopreventive effects were observed in the three cohorts.

4.
Complement Ther Med ; 46: 1-8, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31519264

RESUMEN

OBJECTIVE: To identify empirical evidence on the effectiveness of Tai Chi in treating fibromyalgia (FM). METHOD: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the effectiveness of Tai Chi and standard care or conventional therapeutic exercise in patients with FM. PubMed, Medline, and Physiotherapy Evidence Database were searched for relevant studies published before May 2019. Treatment effectiveness was evaluated using the fibromyalgia impact questionnaire (FIQ), and the total score, pain score, sleep quality index, fatigue, depression, and quality of life were assessing among the patients. RESULTS: Six RCTs with 657 patients were included. Results of our meta-analysis indicated that Tai Chi exerts significant positive effects on reducing the total FIQ score at 12-16 weeks (standard mean difference [SMD]: -0.61; 95% confidence interval [CI]: -0.90 to -0.31) and pain score (SMD: -0.88; 95% CI: -1.58 to -0.18), improving sleep quality (SMD: -0.57; 95% CI: -0.86 to -0.28), relieving fatigue (SMD: -0.92; 95% CI: -1.81 to -0.04), alleviating depression (SMD: -0.49; 95% CI: -0.97 to -0.01), and enhancing quality of life physically (SMD: 6.21; 95% CI: 3.18-9.24) and psychologically (SMD: 5.15; 95% CI: 1.50-8.81). CONCLUSION: Tai Chi exerts significantly greater effects on patients with FM than standard care; therefore, we suggest that Tai Chi can be used as an alternative treatment. However, more large-scale, high-quality, and multicenter trials are required to provide stronger evidence on the effectiveness of Tai Chi, as an alternative to aerobic exercise, compared with conventional therapeutic exercise.


Asunto(s)
Fibromialgia/terapia , Terapia por Ejercicio/métodos , Humanos , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Encuestas y Cuestionarios , Tai Ji/métodos
5.
J Clin Med ; 8(8)2019 Jul 25.
Artículo en Inglés | MEDLINE | ID: mdl-31349746

RESUMEN

OBJECTIVE: A window period of approximately 3-6 months is usually adopted in studies that evaluate hepatic encephalopathy (HE) risk in proton pump inhibitor (PPI) users. However, HE risk after short-term PPI exposure remains unclear. We explored the effect of short-term PPI exposure using a case-crossover study design. DESIGN: Records of patients with decompensated cirrhosis who had received an HE diagnosis were retrieved from the National Health Insurance Research Database. PPI use rates were compared for case and control with window periods of 7, 14, and 28 days. The adjusted self-matched odds ratio (OR) and 95% confidence interval (CI) from a conditional logistic regression model were used to determine the association between PPI use and HE risk. RESULTS: Overall, 13 195 patients were analyzed. The adjusted OR for HE risk after PPI exposure was 3.13 (95% CI = 2.33-4.20) for the 7-day window, 4.77 (95% CI = 3.81-5.98) for the 14-day window, and 5.60 (95% CI = 4.63-6.78) for the 28-day window. All PPI categories, except omeprazole and pantoprazole, were associated with an increased HE risk. Irrespective of other precipitating factors, such as recent gastrointestinal bleeding or infection, PPI significantly increased HE risk. CONCLUSION: Short-term PPI use is significantly associated with HE in patients with decompensated cirrhosis. Physicians should use PPI in these patients for appropriate indications, and carefully monitor signs of HE even after short-term exposure. Owing to the limitations of retrospective design in the current study, further study is warranted to confirm our findings.

6.
Pain Physician ; 22(3): 241-254, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-31151332

RESUMEN

BACKGROUND: Fibromyalgia is a chronic disorder characterized by widespread pain and tenderness. Low-level laser therapy (LLLT), an emerging nonpharmacological treatment, has been used for relieving musculoskeletal or neuropathic pain. OBJECTIVE: The objective of this review and meta-analysis was to determine the efficacy of LLLT on patients with fibromyalgia. STUDY DESIGN: This study involved systematic review and quantitative meta-analysis of published randomized controlled trials (RCTs). SETTING: This study examined all RCTs evaluating the effect of LLLT on fibromyalgia. METHODS: We performed a systematic review and meta-analysis of RCTs evaluating the effect of LLLT on patients with fibromyalgia. PubMed, EMBASE, and the Cochrane Library were searched for articles published before August 2018. RCTs meeting our selection criteria were included. The methodological quality of the RCTs was evaluated according to the Cochrane risk-for-bias method. Review Manager version 5.3 was used to perform the meta-analysis. The primary outcomes were the total scores on the Fibromyalgia Impact Questionnaire (FIQ), pain severity, and number of tender points. The secondary outcomes were changes in fatigue, stiffness, anxiety, and depression. Standardized mean difference (SMD), 95% confidence intervals (CI), and P values were calculated for outcome analysis. RESULTS: We identified 9 RCTs that included 325 fibromyalgia patients undergoing LLLT or placebo laser treatment with or without an exercise program. The meta-analysis showed that patients receiving LLLT demonstrated significantly greater improvement in their FIQ scores (SMD: 1.16; 95% CI, 0.64-1.69), pain severity (SMD: 1.18; 95% CI, 0.82-1.54), number of tender points (SMD: 1.01; 95% CI, 0.49-1.52), fatigue (SMD: 1.4; 95% CI, 0.96-1.84), stiffness (SMD: 0.92; 95% CI, 0.36-1.48), depression (SMD: 1.46; 95% CI, 0.93-2.00), and anxiety (SMD: 1.46; 95% CI, 0.45-2.47) than those receiving placebo laser. Furthermore, when compared with the standardized exercise program alone, LLLT plus the standardized exercise program provided no extra advantage in the relief of symptoms. On the other hand, the results of the only RCT using combined LLLT/LED phototherapy showed significant improvement in most outcomes except for depression when compared to placebo. When compared with pure exercise therapy, combined LLLT/LED phototherapy plus exercise therapy had additional benefits in reducing the severity of pain, number of tender points, and fatigue. LIMITATIONS: There were some limitations in this review, mostly because of the low-to-middle methodological quality of the selected studies; for example, there was no clear allocation process and only patients were blinded in most studies. In addition, one study used per-protocol analysis with a 20% loss to follow-up. On the other hand, the differences in laser types, energy sources, exposure times, and associated medication status in these studies may have resulted in some heterogeneity. CONCLUSIONS: Our results provided the most up-to-date and relevant evidence regarding the effects of LLLT in fibromyalgia. LLLT is an effective, safe, and well-tolerated treatment for fibromyalgia. KEY WORDS: Low-level laser therapy, fibromyalgia, meta-analysis, FIQ, pain, tender points,exercise.


Asunto(s)
Fibromialgia/radioterapia , Terapia por Luz de Baja Intensidad/métodos , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto
8.
Clin Epidemiol ; 10: 1001-1011, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30174459

RESUMEN

Objective: This study aimed to develop and validate a prognostic model for the 1-year risk of late poststroke epilepsy (PSE). Materials and methods: We included patients initially diagnosed with ischemic stroke between 2003 and 2014 in a National Health Insurance claims-based cohort in Taiwan. Patients were further divided into development and validation cohorts based on their year of stroke diagnosis. Multivariable Cox regression with backward elimination was used to analyze the association between 1-year PSE and risk factors before and on stroke admission. Results: In total, 1,684 (1.93%) and 725 (1.87%) ischemic stroke patients comprising the development and validation cohorts, respectively, experienced late PSE within 1 year after stroke. Seven clinical variables were examined to be independently associated with 1-year risk of PSE. We developed a risk score called "PSEiCARe" ranging from 0 to 16 points, comprising the following factors: prolonged hospital stay (>2 weeks, 1 point), seizure on admission (6 points), elderly patients (age ≥80 years, 1 point), intensive care unit stay on admission (3 points), cognitive impairment (dementia, 2 points), atrial fibrillation (2 points), and respiratory tract infection (pneumonia) on admission (1 point). Patients were further classified into low-, medium-, high-, and very-high-risk groups. The incidence (per 100 person-years) was 0.64 (95% CI: 0.56-0.71) for the low-risk, 2.62 (95% CI: 2.43-2.82) for the medium-risk, 10.3 (95% CI: 9.48-11.3) for the high-risk, and 28.2 (95% CI: 24.0-33.0) for the very-high-risk groups. Discrimination and calibration were satisfactory, with a Harrell's C of 0.762 in the development model and 0.792 in the validation model. Conclusion: PSEiCARe is an easy-to-use prognostic score that integrates patient characteristics and clinical factors on stroke admission to predict 1-year PSE risk; it has the potential to assist individualized patient management and improve clinical practice, thereby preventing the occurrence of late PSE.

9.
J Clin Psychiatry ; 78(8): e1006-e1012, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28994901

RESUMEN

OBJECTIVE: Exposure to selective serotonin reuptake inhibitors (SSRIs) has been shown to increase the risk of stroke. In this study, we investigated age and time effects on the risk of first onset stroke in SSRI-exposed (SSRIEXP) adult subjects. METHODS: We analyzed an 8-year cohort from the National Health Insurance Research Database, Taiwan. Patients were defined as SSRIEXP subjects if they received SSRI prescriptions for at least 2 consecutive months during January 1, 2001, to December 31, 2007. Otherwise, they were categorized as SSRI-nonexposed (SSRINONE) subjects. Stroke diagnosis was made according to ICD-9 codes 430-432 (hemorrhagic stroke) and 433-437 (ischemic stroke). RESULTS: Kaplan-Meier survival analysis showed a greater probability of first onset stroke in SSRIEXP than SSRINONE subjects (P < .001). The higher incidence rates in SSRIEXP subjects persisted to the 3 year time point. Ischemic/hemorrhagic stroke cumulative incidence ratios were also higher during the first 3 years in SSRIEXP subjects. Analysis of adjusted hazard ratios indicated that younger SSRIEXP subjects were more likely to experience stroke, with a slight increase of risk in subjects older than 65 years. Stratified analysis of ischemic stroke and hemorrhagic stroke resulted in a similar hazard ratio trend. CONCLUSIONS: Use of SSRIs independently increases the risk of stroke across age strata. The risk is higher in younger adult subjects, and the stroke is more likely to be ischemic than hemorrhagic. The underlying mechanisms of stroke may be related to cerebral microbleeding or an overcorrection of hemostasis function.


Asunto(s)
Isquemia Encefálica , Hemorragias Intracraneales , Inhibidores de la Captación de Serotonina , Accidente Cerebrovascular , Adulto , Factores de Edad , Anciano , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiología , Isquemia Encefálica/etiología , Bases de Datos Factuales , Femenino , Humanos , Incidencia , Hemorragias Intracraneales/diagnóstico , Hemorragias Intracraneales/epidemiología , Hemorragias Intracraneales/etiología , Estimación de Kaplan-Meier , Masculino , Trastornos Mentales/tratamiento farmacológico , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Inhibidores de la Captación de Serotonina/administración & dosificación , Inhibidores de la Captación de Serotonina/efectos adversos , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Análisis de Supervivencia , Taiwán/epidemiología , Factores de Tiempo
10.
Prog Neuropsychopharmacol Biol Psychiatry ; 79(Pt B): 77-83, 2017 10 03.
Artículo en Inglés | MEDLINE | ID: mdl-28583443

RESUMEN

Epidemiological evidence reveals that patients with type 2 diabetes mellitus (T2DM) have an increased risk of neurodegenerative diseases (NDs), including dementia and Parkinson's disease (PD). The effects of metformin exposure on dementia and PD risk in patients with T2DM are unknown. We evaluated the effects of metformin exposure on the risk of dementia and PD in patients with T2DM. We performed a cohort study by using Taiwan's National Health Insurance Research Database. We recruited 4651 patients in the metformin cohort and a comparable number of nonmetformin controls by using propensity score matching. Multivariate Cox proportional hazards regression was used to estimate the effects of metformin on the risk of dementia and PD after adjustment for several confounding factors. During the 12-year follow-up, the metformin cohort exhibited a higher risk of PD than the nonmetformin cohort (hazard ratio [HR]: 2.27, 95% confidence interval [CI]=1.68-3.07). The metformin cohort had an increased risk of all-cause dementia (HR: 1.66, 95% CI=1.35-2.04). Moreover, metformin exposure increased the risk of Alzheimer's disease (HR: 2.13, 95% CI=1.20-3.79) and vascular dementia (HR: 2.30, 95% CI=1.25-4.22). The effects of exposure duration and dosage on dementia and PD occurrence were also observed. Long-term metformin exposure in patients with T2DM may lead to the development of NDs, including dementia and PD. Additional large-scale, prospective controlled trials are required to confirm the observed association in patients with T2DM.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/efectos adversos , Hipoglucemiantes/uso terapéutico , Metformina/efectos adversos , Metformina/uso terapéutico , Enfermedades Neurodegenerativas/epidemiología , Anciano , Comorbilidad , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Relación Dosis-Respuesta a Droga , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Enfermedades Neurodegenerativas/complicaciones , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Taiwán , Factores de Tiempo
11.
Breast ; 33: 132-138, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-28384564

RESUMEN

PURPOSE: Aromatase inhibitor (AI)-induced arthralgia (AIA) is a common side effect that may lead to premature discontinuation of effective hormonal therapy in patients with breast cancer. Acupuncture may relieve joint pain in patients with AIA. We conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate the effectiveness of acupuncture in pain relief in AIA. METHODS: The PubMed, Embase, Cochrane Library, and Scopus databases and the ClinicalTrials.gov registry were searched for studies published before February 2017. Individual effect sizes were standardized, and a meta-analysis was conducted to calculate the pooled effect size by using a random effect model. Pain was assessed using the Brief Pain Inventory (BPI) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at 3-4, 6-8, and 12 weeks. Secondary outcomes included disability level, upper extremity function, physical performance, and quality of life. RESULTS: Five trials involving 181 patients were reviewed. Significant pain reduction was observed after 6-8 weeks of acupuncture treatment. Patients receiving acupuncture showed a significant decrease in the BPI worst pain score (weighted mean difference [WMD]: -3.81, 95% confidence interval [CI]: -5.15 to -2.47) and the WOMAC pain score (WMD: -130.77, 95% CI: -230.31 to -31.22) after 6-8 weeks of treatment. One of the 4 trials reported 18 minor adverse events in 8 patients during 398 intervention episodes. CONCLUSION: Acupuncture is a safe and viable nonpharmacologic treatment that may relieve joint pain in patients with AIA. Additional studies involving a higher number of RCTs are warranted.


Asunto(s)
Terapia por Acupuntura/métodos , Antineoplásicos Hormonales/efectos adversos , Inhibidores de la Aromatasa/efectos adversos , Artralgia/terapia , Neoplasias de la Mama/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Artralgia/inducido químicamente , Femenino , Humanos , Persona de Mediana Edad , Dimensión del Dolor , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
12.
J Clin Gastroenterol ; 51(6): 539-547, 2017 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-28067752

RESUMEN

BACKGROUND: Oral nucleos(t)ide analogs are recommended for patients with chronic hepatitis B virus (HBV)-related acute exacerbation (AE) and acute-on-chronic liver failure (ACLF). The efficacy and safety of administering entecavir (ETV) and lamivudine (LAM) to such patients remain unclear. METHODS: A comprehensive literature search was performed to select studies published before December 2015 on therapy involving ETV or LAM for chronic HBV-related AE with or without ACLF. The main outcomes were short-term (within 4 mo) and long-term (beyond 4 mo) mortality. The secondary outcomes were virological and biochemical responses, ACLF recurrence, and safety. RESULTS: Three prospective and 8 retrospective cohort studies involving 1491 patients were selected. An overall analysis revealed comparable short-term and long-term mortality rates among all patients who received ETV or LAM [short term: risk ratio (RR)=0.99; 95% confidence interval (CI), 0.78-1.27; long term: RR=0.82; 95% CI, 0.45-1.52]. However, in patients with ACLF, ETV yielded a more favorable long-term outcome than did LAM (RR=0.60; 95% CI, 0.45-0.80). Furthermore, ETV resulted in more efficient virological and biochemical responses than did LAM regarding the HBV DNA undetectable rate (RR=1.34; 95% CI, 1.09-1.63), HBV DNA reduction rate (weighted mean difference=-0.41; 95% CI, -0.69 to -0.13), and serum alanine aminotransferase normalization rate (RR=1.13; 95% CI, 1.05-1.21). CONCLUSIONS: ETV and LAM treatments exerted similar effects on the mortality rate of patients with chronic HBV-related AE with or without ACLF. However, ETV yielded a more favorable long-term outcome than did LAM in patients with ACLF; ETV was associated with greater clinical improvements. Additional larger, long-term randomized controlled trials are required to confirm these conclusions.


Asunto(s)
Insuficiencia Hepática Crónica Agudizada/tratamiento farmacológico , Guanina/análogos & derivados , Hepatitis B Crónica/tratamiento farmacológico , Lamivudine/uso terapéutico , Insuficiencia Hepática Crónica Agudizada/mortalidad , Insuficiencia Hepática Crónica Agudizada/virología , Antivirales/efectos adversos , Antivirales/uso terapéutico , Guanina/efectos adversos , Guanina/uso terapéutico , Hepatitis B Crónica/complicaciones , Hepatitis B Crónica/mortalidad , Humanos , Lamivudine/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto
13.
Eur J Intern Med ; 37: 75-82, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-27727075

RESUMEN

BACKGROUND: The association between chronic obstructive pulmonary disease (COPD) and the risk of recurrent peptic ulcer bleeding (PUB) remains unclear. In this study, we compared the risk of recurrent PUB between patients with and those without COPD. METHODS: Using the Taiwan National Health Insurance Research Database, we first selected patients newly diagnosed with PUB in 2002-2009. Two groups comprising 13,732 COPD cases and 13,732 non-COPD matched controls were created using propensity score matching, thereby making the differences in basic demographics, medication use, and disease conditions between the two groups negligible. Cox proportional hazard regression was used to evaluate the risk of recurrent PUB during the follow-up period. RESULTS: The cumulative recurrence rate of PUB was significantly higher in the patients with COPD than in the non-COPD matched controls (2years: 10.8% vs 9.3%; 6years: 18.3% vs 15.7%, P all <0.05), with an adjusted hazard ratio (HR) of 1.17 (95% confidence interval [CI], 1.08-1.26, P<0.001) and 1.19 (95% CI, 1.12-1.26, P<0.001) within 2-year and 6-year follow-ups, respectively. Patients with COPD using steroids were at a marginally higher risk of recurrent PUB than those who did not use steroids. Multivariate stratified analysis revealed similar results in many subgroups. CONCLUSIONS: The risk of recurrent PUB is higher in patients with COPD than in patients without COPD.


Asunto(s)
Úlcera Péptica Hemorrágica/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Adolescente , Adulto , Anciano , Bases de Datos Factuales , Femenino , Glucocorticoides/uso terapéutico , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Análisis Multivariante , Modelos de Riesgos Proporcionales , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Recurrencia , Factores de Riesgo , Taiwán/epidemiología , Adulto Joven
14.
Int J Cardiol ; 220: 462-6, 2016 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-27390970

RESUMEN

OBJECTIVE: The effects of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) on dementia risk in patients with type 2 diabetes mellitus (DM) and hypertension remain unknown. We investigated the effects of ACEIs and ARBs on dementia risk in patients with type 2 DM and hypertension. METHODS: We conducted a cohort study by using the Taiwan National Health Insurance Research Database. We included 2377 patients receiving ACEIs and 1780 patients receiving ARBs in the ACEI and ARB cohorts, respectively. We included a comparable number of patients not receiving ACEIs and ARBs as controls in the non-ACEI and non-ARB cohorts through propensity score matching. The effect of ACEIs and ARBs on dementia risk was estimated through multivariate Cox proportional hazard regression after adjustment for several confounding factors. RESULTS: During the 12-year follow-up period, compared with the non-ACEI cohort, all-cause dementia risk decreased by 26% in the ACEI cohort [hazard ratio (HR)=0.74, 95% confidence interval (CI)=0.56-0.96]. The all-cause dementia risk was nearly 40% lower in the ARB cohort than in the non-ARB cohort (HR=0.60, 95% CI=0.37-0.97). These drugs prevented the occurrence of vascular dementia (VD), however, this effect was nonsignificant for Alzheimer's dementia (AD). Treatment duration- and dosage-related protection effects on dementia occurrence were observed. CONCLUSIONS: ACEIs and ARBs may effectively prevent all-cause dementia, particularly VD, in patients with type 2 DM and hypertension. Moreover, compared with ACEIs, ARBs appear to be more advantageous in dementia prevention.


Asunto(s)
Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Demencia/prevención & control , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipertensión/tratamiento farmacológico , Anciano , Estudios de Cohortes , Bases de Datos Factuales/tendencias , Demencia/diagnóstico , Demencia/epidemiología , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/diagnóstico , Hipertensión/epidemiología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Factores de Riesgo , Taiwán/epidemiología
15.
Eur J Intern Med ; 32: 91-5, 2016 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-27139916

RESUMEN

OBJECTIVE: Recent studies have presented conflicting results on the association between gastric acid suppression and spontaneous bacterial peritonitis (SBP). The long-term effects of gastric acid suppression on SBP in cirrhotic patients remain unclear. This study evaluated the risk of SBP in advanced decompensated cirrhotic patients with long-term gastric acid suppression. METHODS: Using the Taiwan National Health Insurance Research Database, we identified 4788 patients with decompensated cirrhosis from 1998 to 2011. The SBP incidence rate was compared among proton pump inhibitor (PPI), H2-receptor antagonist (H2RA), and control cohorts. Multivariate Cox proportional hazards regressions analysis was conducted to confirm the association between gastric acid suppression and SBP. RESULTS: Totally, 4788 patients were analyzed: 1870 in the PPI cohort, 1728 in the H2RA cohort, and 1190 in the control cohort. The overall incidences of SBP were 16.8, 11.9, and 9.80 per 1000 person-years in the PPI, H2RA, and control cohorts, respectively. The adjusted hazard ratio (aHR) of SBP during the follow-up period was 1.16- (95% confidence interval [CI], 0.72-1.86) and 1.00-fold (95% CI, 0.63-1.57) higher in the PPI and H2RA cohorts, respectively, than in the control cohort; the result was non-significant. Compared with the control cohort, patients with >180days of PPI therapy had significantly higher risks of SBP, with an aHR of 2.28 (95% CI, 1.37-3.78). CONCLUSIONS: Long-term PPI use is associated with a high risk of SBP in advanced decompensated cirrhotic patients. Well-designed prospective studies are necessary to evaluate the safety of long-term PPI use in such patients.


Asunto(s)
Infecciones Bacterianas/epidemiología , Antagonistas de los Receptores Histamínicos H2/uso terapéutico , Cirrosis Hepática/epidemiología , Peritonitis/epidemiología , Inhibidores de la Bomba de Protones/uso terapéutico , Anciano , Estudios de Casos y Controles , Bases de Datos Factuales , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Análisis Multivariante , Modelos de Riesgos Proporcionales , Factores de Riesgo , Índice de Severidad de la Enfermedad , Taiwán/epidemiología
16.
Am J Rhinol Allergy ; 30(3): 215-21, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-27216353

RESUMEN

AIM: To assess the efficacy of intranasal corticosteroid therapy in the treatment of obstructive sleep apnea (OSA) based on current evidence. METHODS: A number of medical literature data bases: PubMed, Cochrane Library, Scopus, and CINAHL, were searched comprehensively to identify randomized controlled trials (RCT) that reported on the efficacy of intranasal corticosteroid therapy for OSA. The selected studies were subjected to a meta-analysis and a risk-of-bias assessment. RESULTS: Seven RCTs met our eligibility criteria, five of these were included in our meta-analysis. The results indicated that intranasal corticosteroid therapy has a better effect in decreasing the apnea-hypopnea index compared with those participants who received placebo (standard mean difference 0.95 [95% confidence interval, -1.42 to -0.47]) (n = 221, I(2) = 62%). CONCLUSION: Our study results showed that patients who received intranasal corticosteroid therapy had a significant improvement in OSA. However, this evidence was limited by the potential risk of bias and heterogeneity of the selected RCTs.


Asunto(s)
Corticoesteroides/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Apnea Obstructiva del Sueño/tratamiento farmacológico , Administración Intranasal , Medicina Basada en la Evidencia , Femenino , Humanos , Masculino
17.
Clin Ther ; 38(4): 874-88, 2016 04.
Artículo en Inglés | MEDLINE | ID: mdl-26923035

RESUMEN

PURPOSE: Obstructive sleep apnea (OSA) is associated with nocturnal hypoxemia, excessive daytime sleepiness (EDS), and sympathetic hyperactivation. Continuous positive airway pressure is the first-line treatment for OSA. However, some patients may have residual EDS. Modafinil and its R-enantiomer, armodafinil, are wakefulness-promoting agents known to be effective in alleviating sleepiness. METHODS: We performed a systematic review and meta-analysis of data from published randomized controlled trials (RCTs) that evaluated the efficacy of modafinil and armodafinil in treating EDS in patients with OSA. Electronic databases, including PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials, were searched for articles on OSA published before October 2015. FINDINGS: We identified 11 RCTs of modafinil involving 723 patients and 5 RCTs of armodafinil involving 1009 patients. A pooled estimate of the mean differences in sleepiness parameters versus placebo were calculated using the random-effects model. Epworth Sleepiness Scale scores improved significantly in the modafinil group (weighted mean difference [WMD], -2.96 [95% confidence interval (CI), -3.73 to -2.19]) and in the armodafinil group (WMD, -2.63; 95% CI, -3.4 to -1.85) compared with those in the placebo group. Sleep latency, as measured on the Maintenance of Wakefulness Test, was significantly prolonged in the modafinil group (WMD, 2.51 [95% CI, 1.5-3.52]) and in the armodafinil group (WMD, 2.71 [95% CI, 0.04-5.37]). Patients tolerated the adverse events with both medications well. IMPLICATIONS: The findings from our study suggest that both modafinil and armodafinil significantly improved subjective and objective daytime sleepiness. Thus, modafinil and armodafinil may be recommended to patients with OSA, particularly those with EDS.


Asunto(s)
Compuestos de Bencidrilo , Apnea Obstructiva del Sueño/tratamiento farmacológico , Promotores de la Vigilia , Compuestos de Bencidrilo/efectos adversos , Compuestos de Bencidrilo/farmacología , Compuestos de Bencidrilo/uso terapéutico , Humanos , Modafinilo , Ensayos Clínicos Controlados Aleatorios como Asunto , Sueño/efectos de los fármacos , Promotores de la Vigilia/efectos adversos , Promotores de la Vigilia/farmacología , Promotores de la Vigilia/uso terapéutico
18.
Phys Ther Sport ; 18: 68-73, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26616689

RESUMEN

OBJECTIVES: To appraise existing evidence of autologous blood injection in treating lateral epicondylosis. DESIGN: Meta-analysis of randomized controlled trials. SETTING: A comprehensive search of the PubMed, Cochrane, SCOPUS, and CINAHL databases was performed to identify randomized controlled trials that reported the efficacy of autologous blood injection in treating lateral epicondylosis. The selected studies were subjected to a meta-analysis and risk of bias assessment. PARTICIPANTS: Patients with lateral epicondylosis. MAIN OUTCOME MEASURES: Pain-related measurement in each selected randomized controlled trial was pooled into meta-analysis. RESULTS: Nine randomized controlled trials were included in the analysis. The results of the meta-analysis including the pain scores indicated that autologous blood injection is more effective compared with corticosteroid injection (standard mean difference: -0.75; 95% confidence interval: -1.14 to -0.37) but not more effective compared with platelet-rich plasma injection (standard mean difference: 0.09; 95% confidence interval: -0.66 to 0.84). The risk of bias assessment indicated that all the included trials exhibited a moderate to high risk of bias. CONCLUSION: Autologous blood injection is more effective than corticosteroid injection but not more effective than platelet-rich plasma injection in treating lateral epicondylosis. However, this evidence is limited by the potential risk of bias.


Asunto(s)
Transfusión de Plaquetas/métodos , Plasma Rico en Plaquetas , Ensayos Clínicos Controlados Aleatorios como Asunto , Codo de Tenista/terapia , Transfusión de Sangre Autóloga/métodos , Humanos , Inyecciones
19.
BMC Neurol ; 15: 39, 2015 Mar 22.
Artículo en Inglés | MEDLINE | ID: mdl-25886512

RESUMEN

BACKGROUND: Postpolio syndrome (PPS) is characterized by progressive disabilities that develop decades after prior paralytic poliomyelitis. Because chronic inflammation may be the process underlying the development of PPS, immunomodulatory management, such as intravenous immunoglobulin (IVIg) administration, may be beneficial. METHODS: We performed a systematic review and meta-analysis of published randomized controlled trials (RCTs) and prospective studies that evaluated the efficacy of IVIg in managing PPS. Electronic databases, including PubMed, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials, were searched for articles on PPS published before December 2014. The primary outcomes were pain severity, fatigue scores, and muscle strength. The secondary outcomes were physical performance, quality of life (QoL), and cytokine expression levels. RESULTS: We identified 3 RCTs involving 241 patients and 5 prospective studies involving 267 patients. The meta-analysis of pain severity (weighted mean difference [WMD] = -1.02, 95% confidence interval [CI] = -2.51 to 0.47), fatigue scores (WMD = 0.28, 95% CI -0.56 to 1.12), and muscle strength revealed no significant differences between the IVIg and the placebo group. Regarding QoL, the RCTs yielded controversial outcomes, with improvement in only certain domains of the Short Form 36 (SF-36). Moreover, one prospective study reported significant improvement on SF-36, particularly in patients aged younger than 65 years, those with paresis of the lower limbs, and high pain intensity. CONCLUSION: The present review indicated that IVIg is unlikely to produce significant improvements in pain, fatigue, or muscle strength. Thus, routinely administering IVIg to patients with PPS is not recommended based on RCTs. However, a potential effect in younger patients with lower limbs weakness and intense pain requires confirmation from further well-structured trials.


Asunto(s)
Fatiga/tratamiento farmacológico , Inmunoglobulinas Intravenosas/uso terapéutico , Factores Inmunológicos/uso terapéutico , Debilidad Muscular/tratamiento farmacológico , Dolor/tratamiento farmacológico , Síndrome Pospoliomielitis/tratamiento farmacológico , Fatiga/etiología , Humanos , Fuerza Muscular , Debilidad Muscular/etiología , Dolor/etiología , Síndrome Pospoliomielitis/complicaciones , Estudios Prospectivos , Calidad de Vida , Resultado del Tratamiento
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