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1.
Artículo en Inglés | MEDLINE | ID: mdl-32438898

RESUMEN

Confirmed cases in Australia notified up to 10 May 2020: notifications = 6,971; deaths = 98. The incidence of new cases of COVID-19 has reduced dramatically since a peak in mid-March. The reduction in international travel, social distancing measures and public health action have likely been effective in slowing the spread of the disease, in the Australian community. Cases of COVID-19 continue to be notified by jurisdictions, albeit at a slowed rate. Testing rates over the past week have increased markedly, with a very low proportion of people testing positive. These low rates of detection are indicative of low levels of COVID-19 transmission. It is important that testing rates and community adherence to public health measures remain high to support the continued suppression of the virus, particularly in vulnerable high-risk groups and settings. In the past reporting week new cases in Australia are mostly considered to be locally acquired, consistent with the drop in international travel. Most locally-acquired cases can be linked back to a known case or cluster. Although the proportion of locally-acquired cases has increased, the overall rate of cases, regardless of place of acquisition, continues to decrease. The crude case fatality rate in Australia remains low (1.4%), compared with the WHO reported global rate (6.9%). The low case fatality rate is likely reflective of high case detection and high quality of health care services in Australia. Deaths from COVID-19 in Australia have occurred predominantly among the elderly and those with comorbidities, with no deaths occurring in those under 40 years. The highest rate of COVID-19 continues to be among people aged 60-79 years, with a third of these cases associated with several outbreaks linked to cruise ships. The lowest rate of disease is in young children, a pattern reflected in international reports. Internationally, cases continue to increase, with some areas such as Brazil and India showing a dramatic rise in reported cases. Although some low-income countries have currently reported few cases, it is possible that this is due to limited diagnostic and public health capacity, and may not be reflective of disease occurrence.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Niño , Preescolar , Trazado de Contacto , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Humanos , Lactante , Recién Nacido , Tamizaje Masivo , Persona de Mediana Edad , Pandemias/prevención & control , Neumonía Viral/diagnóstico , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Vigilancia en Salud Pública , Adulto Joven
3.
Am Surg ; 86(4): 308-312, 2020 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-32391754

RESUMEN

Acute diverticulitis is an emergency surgical condition that is commonly managed via an acute surgical unit model. Operative surgery is indicated in selected situations including generalized peritonitis or fistulous disease; however, limited data exist on how borderline patients potentially needing surgery may be salvaged by close clinical management with modern interventional techniques. The aims of the study were to identify the operative surgery rates in acute diverticulitis and predictors for identifying patients with complicated diverticulitis. Retrospective data collection was performed on a prospectively held database at a high-volume acute surgical unit at Logan Hospital, Queensland. Patient demographic data, disease-related factors, and treatment-related factors were collected for reporting and analysis. Over three years (2016-2018), 201 patients (64%) were admitted with uncomplicated diverticulitis and 113 patients (36%) with complicated diverticulitis. An observable downward trend was noted in the number of yearly admissions for uncomplicated diverticulitis. Complicated diverticulitis was associated with male gender (P = 0.039), increased length of hospital stay (P < 0.001), temperature ≥37.5 (P = 0.025), increased white cell count (P < 0.001), and elevated C-reactive protein (P < 0.001). Twelve patients (11%) with complicated diverticulitis initially failed conservative management. Seven patients (6%) underwent a definitive Hartmann's procedure, and 5 patients (4%) underwent percutaneous drainage of abscesses. Acute diverticulitis can be safely managed nonoperatively by medical therapy and percutaneous drainage of abscesses, with surgery reserved for patients with complicated diverticulitis with sepsis or peritonitis.


Asunto(s)
Antibacterianos/uso terapéutico , Diverticulitis del Colon/terapia , Drenaje , Absceso Abdominal/tratamiento farmacológico , Absceso Abdominal/etiología , Absceso Abdominal/cirugía , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Australia , Colostomía , Diverticulitis del Colon/complicaciones , Diverticulitis del Colon/tratamiento farmacológico , Diverticulitis del Colon/cirugía , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Peritonitis/etiología , Peritonitis/cirugía , Estudios Retrospectivos
5.
Artículo en Inglés | MEDLINE | ID: mdl-32418510

RESUMEN

The number of notified cases of invasive pneumococcal disease (IPD) in the second quarter of 2019 was higher than the previous quarter as well as the second quarter of 2018. Following the July 2011 replacement of the 7-valent pneumococcal conjugate vaccine (7vPCV) in the childhood immunisation program with the 13-valent pneumococcal conjugate vaccine (13vPCV), there was an initial relatively rapid decline in disease due to the additional six serotypes covered by the 13vPCV across all age groups, however more recently this decline is no longer evident. Over this period the number of cases due to the eleven serotypes additionally covered by the 23-valent pneumococcal polysaccharide vaccine (23vPPV), and also those serotypes not covered by any available vaccine, has been increasing steadily across all age groups.


Asunto(s)
Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/inmunología , Vigilancia de la Población , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Australia , Niño , Preescolar , Notificación de Enfermedades , Humanos , Lactante , Recién Nacido , Persona de Mediana Edad , Vacunas Neumococicas/administración & dosificación , Streptococcus pneumoniae/inmunología , Factores de Tiempo , Adulto Joven
6.
Artículo en Inglés | MEDLINE | ID: mdl-32418512

RESUMEN

The number of notified cases of invasive pneumococcal disease (IPD) in the third quarter of 2019 was higher than in the previous quarter, but lower than in the third quarter of 2018. Following the July 2011 replacement of the 7-valent pneumococcal conjugate vaccine (7vPCV) in the childhood immunisation program with the 13-valent pneumococcal conjugate vaccine (13vPCV), there was an initial relatively rapid decline in disease due to the additional six serotypes covered by the 13vPCV across all age groups, however more recently this decline is no longer evident. Over this period the number of cases due to the eleven serotypes additionally covered by the 23-valent pneumococcal polysaccharide vaccine (23vPPV), and also those serotypes not covered by any available vaccine, has been increasing steadily across all age groups.


Asunto(s)
Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/inmunología , Vigilancia de la Población , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Australia , Niño , Preescolar , Notificación de Enfermedades , Humanos , Lactante , Recién Nacido , Persona de Mediana Edad , Vacunas Neumococicas/administración & dosificación , Serogrupo , Streptococcus pneumoniae/clasificación , Streptococcus pneumoniae/inmunología , Factores de Tiempo , Adulto Joven
7.
Pestic Biochem Physiol ; 166: 104583, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32448413

RESUMEN

Insecticides of the tetronic/tetramic acid family (cyclic ketoenols) are widely used to control sucking pests such as whiteflies, aphids and mites. They act as inhibitors of acetyl-CoA carboxylase (ACC), a key enzyme for lipid biosynthesis across taxa. While it is well documented that plant ACCs targeted by herbicides have developed resistance associated with mutations at the carboxyltransferase (CT) domain, resistance to ketoenols in invertebrate pests has been previously associated either with metabolic resistance or with non-validated candidate mutations in different ACC domains. A recent study revealed high levels of spiromesifen and spirotetramat resistance in Spanish field populations of the whitefly Bemisia tabaci that was not thought to be associated with metabolic resistance. We confirm the presence of high resistance levels (up to >640-fold) against ketoenol insecticides in both Spanish and Australian B. tabaci strains of the MED and MEAM1 species, respectively. RNAseq analysis revealed the presence of an ACC variant bearing a mutation that results in an amino acid substitution, A2083V, in a highly conserved region of the CT domain. F1 progeny resulting from reciprocal crosses between susceptible and resistant lines are almost fully resistant, suggesting an autosomal dominant mode of inheritance. In order to functionally investigate the contribution of this mutation and other candidate mutations previously reported in resistance phenotypes, we used CRISPR/Cas9 to generate genome modified Drosophila lines. Toxicity bioassays using multiple transgenic fly lines confirmed that A2083V causes high levels of resistance to commercial ketoenols. We therefore developed a pyrosequencing-based diagnostic assay to map the spread of the resistance alleles in field-collected samples from Spain. Our screening confirmed the presence of target-site resistance in numerous field-populations collected in Sevilla, Murcia and Almeria. This emphasizes the importance of implementing appropriate resistance management strategies to prevent or slow the spread of resistance through global whitefly populations.


Asunto(s)
Acetil-CoA Carboxilasa , Resistencia a los Insecticidas , Animales , Australia , Mutación , España
9.
Crit Care Resusc ; 22(2): 133-141, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32389105

RESUMEN

BACKGROUND: Contemporary glucose management of intensive care unit (ICU) patients with type 2 diabetes is based on trial data derived predominantly from patients without type 2 diabetes. This is despite the recognition that patients with type 2 diabetes may be relatively more tolerant of hyperglycaemia and more susceptible to hypoglycaemia. It is uncertain whether glucose targets should be more liberal in patients with type 2 diabetes. OBJECTIVE: To detail the protocol, analysis and reporting plans for a randomised clinical trial - the Liberal Glucose Control in Critically Ill Patients with Pre-existing Type 2 Diabetes (LUCID) trial - which will evaluate the risks and benefits of targeting a higher blood glucose range in patients with type 2 diabetes. DESIGN, SETTING, PARTICIPANTS AND INTERVENTION: A multicentre, parallel group, open label phase 2B randomised controlled clinical trial of 450 critically ill patients with type 2 diabetes. Patients will be randomised 1:1 to liberal blood glucose (target 10.0-14.0 mmol/L) or usual care (target 6.0-10.0 mmol/L). MAIN OUTCOME MEASURES: The primary endpoint is incident hypoglycaemia (< 4.0 mmol/L) during the study intervention. Secondary endpoints include biochemical and feasibility outcomes. RESULTS AND CONCLUSION: The study protocol and statistical analysis plan described will delineate conduct and analysis of the trial, such that analytical and reporting bias are minimised. TRIAL REGISTRATION: This trial has been registered on the Australian New Zealand Clinical Trials Registry (ACTRN No. 12616001135404) and has been endorsed by the Australian and New Zealand Intensive Care Society Clinical Trials Group.


Asunto(s)
Glucemia/metabolismo , Protocolos de Ensayos Clínicos como Asunto , Cuidados Críticos , Diabetes Mellitus Tipo 2/complicaciones , Ensayos Clínicos Controlados Aleatorios como Asunto , Australia , Enfermedad Crónica , Enfermedad Crítica , Diabetes Mellitus Tipo 2/sangre , Humanos , Nueva Zelanda
10.
Crit Care Resusc ; 22(2): 152-157, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32389107

RESUMEN

OBJECTIVE: To determine the frequency, indications and complications associated with the use of faecal diversion systems (rectal tubes) in critically ill patients. DESIGN: A single centre observational study over 15 months. SETTING: Intensive care unit (ICU). PARTICIPANTS: Patients admitted during this period. MAIN OUTCOME MEASURES: Frequency of rectal tubes utilisation in ICU, as well as associated adverse events, with major events defined as lower gastrointestinal bleeding associated with defined blood transfusion of two or more units of red cells or endoscopy or surgical intervention. RESULTS: Of 3418 admission episodes, there were 111 episodes of rectal tubes inserted in 99 patients. Rectal tubes remained indwelling for a median of 5 days (range, 1-23) for a total of 641 patient-days. The most frequent indication for insertion was excessive bowel motions. A major adverse event was observed in three patients (3%; 0.5 events per 100 device days). Two patients underwent laparotomy and one patient sigmoidoscopy. These patients received between two and 23 units of packed red blood cells. Patients who had a rectal tube inserted had a substantially greater duration of ICU admission (mean, 14 days [SD, 14] v 2.8 days [SD, 3.7]) and hospital mortality (15% v 7.7%; risk ratio, 2.0; 95% CI, 1.2-3.4) as well as an overall higher Australian and New Zealand Risk of Death (ANZROD) score (mean, 27 [SD, 22] v 12.6 [SD, 20]). CONCLUSION: Rectal tubes appear to be frequently inserted and can lead to major adverse events in critically ill patients.


Asunto(s)
Enfermedad Crítica , Heces , Unidades de Cuidados Intensivos , Recto/cirugía , Adulto , Australia , Transfusión Sanguínea , Mortalidad Hospitalaria , Humanos
11.
Crit Care Resusc ; 22(2): 158-165, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32389108

RESUMEN

OBJECTIVE: Hyperammonaemia contributes to complications in acute liver failure (ALF) and may be treated with continuous renal replacement therapy (CRRT), but current practice is poorly understood. DESIGN: We retrospectively analysed data for baseline characteristics, ammonia concentration, CRRT use, and outcomes in a cohort of Australian and New Zealand patients with ALF. SETTING: All liver transplant ICUs across Australia and New Zealand. PARTICIPANTS: Sixty-two patients with ALF. MAIN OUTCOME MEASURES: Impact of CRRT on hyperammonaemia and patient outcomes. RESULTS: We studied 62 patients with ALF. The median initial (first 24 h) peak ammonia was 132 µmol/L (interquartile range [IQR], 91-172), median creatinine was 165 µmol/L (IQR, 92-263) and median urea was 6.9 mmol/L (IQR, 3.1-12.0). Most patients (43/62, 69%) received CRRT within a median of 6 hours (IQR, 2-12) of ICU admission. At CRRT commencement, three-quarters of such patients did not have Stage 3 acute kidney injury (AKI): ten patients (23%) had no KDIGO creatinine criteria for AKI, 12 (28%) only had Stage 1, and ten patients (23%) had Stage 2 AKI. Compared with non-CRRT patients, those treated with CRRT had higher ammonia concentrations (median, 141 µmol/L [IQR, 102-198] v 91 µmol/L [IQR, 54-115]; P = 0.02), but a nadir Day 1 pH of only 7.25 (standard deviation, 0.16). Prevention of extreme hyperammonaemia (> 140 µmol/L) after Day 1 was achieved in 36 of CRRT-treated patients (84%) and was associated with transplant-free survival (55% v 13%; P = 0.05). CONCLUSION: In Australian and New Zealand patients with ALF, CRRT is typically started early, before Stage 3 AKI or severe acidaemia, and in the presence hyperammonaemia. In these more severely ill patients, CRRT use was associated with prevention of extreme hyperammonaemia, which in turn, was associated with increased transplant-free survival.


Asunto(s)
Lesión Renal Aguda/terapia , Amoníaco/sangre , Terapia de Reemplazo Renal Continuo/métodos , Hiperamonemia/prevención & control , Fallo Hepático Agudo/cirugía , Australia , Humanos , Hiperamonemia/sangre , Fallo Hepático Agudo/sangre , Trasplante de Hígado , Nueva Zelanda , Estudios Retrospectivos , Resultado del Tratamiento
13.
Artículo en Inglés | MEDLINE | ID: mdl-32393161

RESUMEN

Confirmed cases in Australia notified up to 03 May 2020: notifications = 6,784; deaths = 89. The reduction in international travel and domestic movement, social distancing measures and public health action have likely slowed the spread of COVID-19 in Australia. Currently new notifications in Australia are mostly considered to be locally-acquired with some cases still reported among people with recent overseas travel. Most locally-acquired cases can be linked back to a confirmed case or known cluster, with a small portion unable to be epidemiologically linked to another case. The ratio of overseas-acquired cases to locally-acquired cases varies by jurisdiction. The crude case fatality rate (CFR) in Australia remains low (1.3%) compared to the World Health Organization's globally-reported rate (7.1%) and to other comparable high-income countries such as the United States of America (5.7%) and the United Kingdom (15.4%). The lower CFR in Australia is likely reflective of high case ascertainment including detection of mild cases. Internationally, cases continue to increase. The rates of increase have started to slow in several regions, although it is too soon to tell whether this trend will be sustained.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Vigilancia de la Población , Salud Pública , Adulto Joven
14.
Bone Joint J ; 102-B(5): 550-555, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32349593

RESUMEN

The cost of clinical negligence in the UK has continued to rise despite no increase in claims numbers from 2016 to 2019. In the US, medical malpractice claim rates have fallen each year since 2001 and the payout rate has stabilized. In Germany, malpractice claim rates for spinal surgery fell yearly from 2012 to 2017, despite the number of spinal operations increasing. In Australia, public healthcare claim rates were largely static from 2008 to 2013, but private claims rose marginally. The cost of claims rose during the period. UK and Australian trends are therefore out of alignment with other international comparisons. Many of the claims in orthopaedics occur as a result of "failure to warn", i.e. lack of adequately documented and appropriate consent. The UK and USA have similar rates (26% and 24% respectively), but in Germany the rate is 14% and in Australia only 2%. This paper considers the drivers for the increased cost of clinical negligence claims in the UK compared to the USA, Germany and Australia, from a spinal and orthopaedic point of view, with a focus on "failure to warn" and lack of compliance with the principles established in February 2015 in the Supreme Court in the case of Montgomery v Lanarkshire Health Board. The article provides a description of the prevailing medicolegal situation in the UK and also calculates, from publicly available data, the cost to the public purse of the failure to comply with the principles established. It shows that compliance with the Montgomery principles would have an immediate and lasting positive impact on the sums paid by NHS Resolution to settle negligence cases in a way that has already been established in the USA. Cite this article: Bone Joint J 2020;102-B(5):550-555.


Asunto(s)
Consentimiento Informado/legislación & jurisprudencia , Mala Praxis/legislación & jurisprudencia , Procedimientos Ortopédicos/legislación & jurisprudencia , Medicina Estatal/legislación & jurisprudencia , Australia , Alemania , Humanos , Consentimiento Informado/ética , Medicina Estatal/ética , Decisiones de la Corte Suprema , Reino Unido , Estados Unidos
15.
Artículo en Inglés | MEDLINE | ID: mdl-32362270

RESUMEN

Confirmed cases in Australia notified up to 26 April 2020: notifications = 6,711; deaths = 77. The reduction in international travel and domestic movement, social distancing measures and public health action have likely slowed the spread of COVID-19 in Australia. Notifications in Australia remain predominantly among people with recent overseas travel, with some locally-acquired cases being detected. Most locally-acquired cases can be linked back to a confirmed case, with a small portion unable to be epidemiologically linked to another case. The ratio of overseas-acquired cases to locally-acquired cases varies by jurisdiction. The crude case fatality rate (CFR) in Australia remains low (1.1%) compared to the World Health Organization's globally-reported rate (6.9%) and to other comparable high-income countries such as the United States of America (5.1%) and the United Kingdom (13.7%). The lower CFR in Australia is likely reflective of high case ascertainment including detection of mild cases. High case ascertainment and prompt identification of contacts enables an effective public health response and a reduction of disease transmission. Internationally, cases continue to increase. The rates of increase have started to slow in several regions, although it is too soon to tell whether this trend will be sustained. Interpretation of international epidemiology should be conducted with caution as it differs from country to country depending not only on the disease dynamics, but also on differences in case detection, testing and implemented public health measures.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Australia/epidemiología , Infecciones por Coronavirus/prevención & control , Humanos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Salud Pública
17.
J Dent Educ ; 84(4): 449-457, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32314388

RESUMEN

Student-led conferences are a type of inquiry learning and student-led pedagogy. They have the potential to foster learning across many of the domains required for professional dental practice including communication and interpersonal skills, adaptive capability, professional attitude and ethical judgment, entrepreneurship, and a social and community orientation. A student-led conference, which provided a framework for students studying oral biosciences to create and host a conference focused on contemporary issues in oral biosciences, was introduced into the Bachelor of Oral Health program at the University of Sydney in Australia in 2017 and 2018. The aim of this qualitative study was to examine the educational purposes that the student-led conference satisfied. Data were collected from the 2017 cohort of students in the form of reflective essays. In 2018, students' experience of the conference was recorded from a focus group discussion. In both years, reflective accounts written by attendees were collected. The thematic analysis generated four themes: integration of learning, personal learning, student resourcefulness through peer relationships, and deep commitment to delivering an excellent conference. The learning project served as a platform for students to display their professionalism and skills gained in entrepreneurship, communication, and adaptive capability. This study provided an example of a participatory curriculum approach with the potential to help students generate a working understanding of knowledge structures and how knowledge is created and circulates in the discipline.


Asunto(s)
Curriculum , Educación en Odontología , Australia , Humanos , Aprendizaje , Estudiantes
18.
J Laryngol Otol ; 134(4): 328-331, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32234081

RESUMEN

OBJECTIVE: Convolutional neural networks are a subclass of deep learning or artificial intelligence that are predominantly used for image analysis and classification. This proof-of-concept study attempts to train a convolutional neural network algorithm that can reliably determine if the middle turbinate is pneumatised (concha bullosa) on coronal sinus computed tomography images. METHOD: Consecutive high-resolution computed tomography scans of the paranasal sinuses were retrospectively collected between January 2016 and December 2018 at a tertiary rhinology hospital in Australia. The classification layer of Inception-V3 was retrained in Python using a transfer learning method to interpret the computed tomography images. Segmentation analysis was also performed in an attempt to increase diagnostic accuracy. RESULTS: The trained convolutional neural network was found to have diagnostic accuracy of 81 per cent (95 per cent confidence interval: 73.0-89.0 per cent) with an area under the curve of 0.93. CONCLUSION: A trained convolutional neural network algorithm appears to successfully identify pneumatisation of the middle turbinate with high accuracy. Further studies can be pursued to test its ability in other clinically important anatomical variants in otolaryngology and rhinology.


Asunto(s)
Inteligencia Artificial/normas , Enfermedades Nasales/etiología , Senos Paranasales/diagnóstico por imagen , Tomografía Computarizada por Rayos X/instrumentación , Cornetes Nasales/diagnóstico por imagen , Algoritmos , Australia/epidemiología , Femenino , Humanos , Masculino , Redes Neurales de la Computación , Enfermedades Nasales/diagnóstico por imagen , Enfermedades Nasales/patología , Enfermedades Nasales/cirugía , Variaciones Dependientes del Observador , Estudios Retrospectivos , Cornetes Nasales/patología , Cornetes Nasales/cirugía
19.
J Laryngol Otol ; 134(4): 323-327, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32241312

RESUMEN

OBJECTIVE: The nasal septal swell body is a normal anatomical structure located in the superior nasal septum anterior to the middle turbinate. However, the impact of the septal swell body in nasal breathing during normal function and disease remains unclear. This study aimed to establish that the septal swell body varies in size over time and correlates this with the natural variation of the inferior turbinates. METHOD: Consecutive patients who underwent at least two computed tomography scans were identified. The width and height of the septal swell body and the inferior turbinates was recorded. A correlation between the difference in septal swell body and turbinates between the two scans was performed using a Pearson's coefficient. RESULTS: A total of 34 patients (53 per cent female with a mean age of 58.3 ± 20.2 years) were included. The mean and mean difference in septal swell body width between scans for the same patient was 1.57 ± 1.00 mm. The mean difference in turbinate width between scans was 2.23 ± 2.52 mm. A statistically significant correlation was identified between the difference in septal swell body and total turbinate width (r = 0.35, p = 0.04). CONCLUSION: The septal swell body is a dynamic structure that varies in width over time in close correlation to the inferior turbinates. Further research is required to quantify its relevance as a surgical area of interest.


Asunto(s)
Obstrucción Nasal/patología , Tabique Nasal/diagnóstico por imagen , Rinitis/patología , Cornetes Nasales/diagnóstico por imagen , Adulto , Anciano , Australia/epidemiología , Femenino , Humanos , Hipertrofia , Masculino , Persona de Mediana Edad , Obstrucción Nasal/etiología , Obstrucción Nasal/terapia , Tabique Nasal/patología , Senos Paranasales/diagnóstico por imagen , Hueso Petroso/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Cornetes Nasales/patología
20.
Lancet ; 395(10234): 1444-1451, 2020 05 02.
Artículo en Inglés | MEDLINE | ID: mdl-32234534

RESUMEN

BACKGROUND: Catheter-based renal denervation has significantly reduced blood pressure in previous studies. Following a positive pilot trial, the SPYRAL HTN-OFF MED (SPYRAL Pivotal) trial was designed to assess the efficacy of renal denervation in the absence of antihypertensive medications. METHODS: In this international, prospective, single-blinded, sham-controlled trial, done at 44 study sites in Australia, Austria, Canada, Germany, Greece, Ireland, Japan, the UK, and the USA, hypertensive patients with office systolic blood pressure of 150 mm Hg to less than 180 mm Hg were randomly assigned 1:1 to either a renal denervation or sham procedure. The primary efficacy endpoint was baseline-adjusted change in 24-h systolic blood pressure and the secondary efficacy endpoint was baseline-adjusted change in office systolic blood pressure from baseline to 3 months after the procedure. We used a Bayesian design with an informative prior, so the primary analysis combines evidence from the pilot and Pivotal trials. The primary efficacy and safety analyses were done in the intention-to-treat population. This trial is registered at ClinicalTrials.gov, NCT02439749. FINDINGS: From June 25, 2015, to Oct 15, 2019, 331 patients were randomly assigned to either renal denervation (n=166) or a sham procedure (n=165). The primary and secondary efficacy endpoints were met, with posterior probability of superiority more than 0·999 for both. The treatment difference between the two groups for 24-h systolic blood pressure was -3·9 mm Hg (Bayesian 95% credible interval -6·2 to -1·6) and for office systolic blood pressure the difference was -6·5 mm Hg (-9·6 to -3·5). No major device-related or procedural-related safety events occurred up to 3 months. INTERPRETATION: SPYRAL Pivotal showed the superiority of catheter-based renal denervation compared with a sham procedure to safely lower blood pressure in the absence of antihypertensive medications. FUNDING: Medtronic.


Asunto(s)
Hipertensión/cirugía , Riñón/inervación , Riñón/cirugía , Adulto , Antihipertensivos/normas , Australia/epidemiología , Austria/epidemiología , Teorema de Bayes , Presión Sanguínea/fisiología , Canadá/epidemiología , Femenino , Alemania/epidemiología , Grecia/epidemiología , Humanos , Hipertensión/diagnóstico , Hipertensión/etnología , Irlanda/epidemiología , Japón/epidemiología , Riñón/fisiopatología , Masculino , Persona de Mediana Edad , Placebos/efectos adversos , Estudios Prospectivos , Simpatectomía/métodos , Resultado del Tratamiento , Reino Unido/epidemiología , Estados Unidos/epidemiología
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