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1.
Medicine (Baltimore) ; 99(12): e19500, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32195950

RESUMEN

BACKGROUND: Lesions of herpes labialis are caused by the herpes simplex virus type 1 and cause pain and aesthetic compromise. It is characterized by the formation of small vesicles that coalesce and rupture forming extremely painful ulcers, that evolve to crusts, dry desquamations until their complete remission. Currently the treatment of these lesions is done with acyclovir. Although it diminishes the symptomatology, it causes viral resistance and does not prevent the recurrence of the lesions. It is known that antimicrobial photodynamic therapy (aPDT) has numerous advantages, among them: the reduction of the time of remission, and does not cause resistance. This protocol will determine the effectiveness of PDT in lesions of herpes labialis. MATERIALS AND METHODS: A total of 30 patients with herpes labialis in the prodromal stage of vesicles, ulcers, and crusts will be selected to participate in the study and randomized into 2 groups: G1 control and G2 experimental. After signing Research Ethics Committee and TA, patients in group G1 will undergo the standard gold treatment for herpes labialis with acyclovir and simulated PDT treatment. Patients in the experimental G2 group will be treated simulating the gold standard treatment of herpes labialis (placebo) and PDT. In all patients, saliva samples will be collected for analysis of cytokines, and will be performed exfoliative cytology in the lesions. The pain will be assessed through a pain scale and a questionnaire of quality of life related to oral health (OHIP-14) will be given to them. Patients will continue to be followed up after 7 days, 1 month, 3 months, and 6 months; if there is a recurrence of the lesion, they will contact the researchers.Clinical registration: clinicaltrials.gov - NCT04037475. Registered on July 2019.


Asunto(s)
Aciclovir/uso terapéutico , Antivirales/uso terapéutico , Herpes Labial/terapia , Fotoquimioterapia/métodos , Aciclovir/efectos adversos , Adulto , Antivirales/efectos adversos , Femenino , Herpes Labial/patología , Herpes Labial/virología , Herpesvirus Humano 1/aislamiento & purificación , Herpesvirus Humano 1/efectos de la radiación , Humanos , Masculino , Dolor/etiología , Estudios Prospectivos , Calidad de Vida , Recurrencia , Úlcera/patología , Escala Visual Analógica , Adulto Joven
2.
Rev Infirm ; 69(257): 32-34, 2020 Jan.
Artículo en Francés | MEDLINE | ID: mdl-32146963

RESUMEN

Health professionals working in paediatric oncology met in Bamako, Mali, as part of a healthcare partnership between the Gabriel-Touré Hospital in Bamako and the Curie Institute in Paris. Open to dialogue and intercultural encounters, the hospital medical and paramedical teams exchanged views on their practices with a particular focus on pain management.


Asunto(s)
Personal de Salud/psicología , Cooperación Internacional , Conocimiento , Manejo del Dolor , Niño , Humanos , Malí , Neoplasias/complicaciones , Dolor/etiología , Paris
3.
Rev Soc Bras Med Trop ; 53: e20190285, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32187336

RESUMEN

This reports a case of scorpionism caused by Tityus serrulatus. A male adult was stung while unloading bananas at the supply center in Belém, Pará, Brazil. The bananas originated in another state (Bahia) and were brought to Belém by truck. The patient presented with pain, edema, and erythema at the sting site, and was classified as low-risk. The specimen was identified as T. serrulatus and symptomatic treatment and clinical observation were advised. The patient was discharged later without further complications. This is the first known envenomation caused by T. serrulatus, a non-native species to Pará, in the Brazilian Amazon.


Asunto(s)
Picaduras de Escorpión/diagnóstico , Escorpiones/clasificación , Adulto , Animales , Brasil , Humanos , Masculino , Dolor/etiología , Picaduras de Escorpión/complicaciones
4.
Medicine (Baltimore) ; 99(9): e19306, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32118751

RESUMEN

The study aimed to explore whether cancer-related pain and opioids use are associated with the survival of cancer patients, and perform a cohort study and a meta-analysis to quantify the magnitude of any association.A retrospective cohort study was performed to analyze the impact of pain level, and opioids use on cancer-specific survival (CSS) in advanced cancer patients. Patients and relevant medical records were selected from the registry of the Radiation and chemotherapy division of Ningbo First Hospital between June 2013 and October 2017. Hazard ratios (HRs) and 95% confidential intervals (CIs) for CSS by opioids use were calculated by univariate and multivariate Cox regression analyses. The systematic review included relevant studies published before October 2018. The combined HRs and 95% CIs for overall survival (OS) and progression-free survival (PFS) were calculated using random-effect models.A total of consecutive 203 cancer patients were included in the cohort study. Kaplan-Meier curves indicate a negative association between CSS and cancer-related pain or opioids requirement, but less evidence of an association with the dose of opioids use. Multivariate models revealed that the pain level and opioids requirement were associated with shorter CSS, after adjusting for significant covariates. The results of the meta-analysis indicated that postoperative opioids use had a poor effect on PFS, and opioids use for cancer-related pain was associated with poor OS in cancer patients, while intraoperative opioids use was not associated with cancer survival.We concluded that cancer-related pain and opioids requirements are associated with poor survival in advanced cancer patients, and postoperative opioids use and opioids use for cancer-related pain may have an adverse effect on the survival of cancer patients.


Asunto(s)
Analgésicos Opioides/normas , Neoplasias/tratamiento farmacológico , Neoplasias/mortalidad , Dolor/tratamiento farmacológico , Adulto , Anciano , Analgésicos Opioides/uso terapéutico , Análisis de Varianza , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Dolor/etiología , Manejo del Dolor/métodos , Manejo del Dolor/normas , Manejo del Dolor/estadística & datos numéricos , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Análisis de Supervivencia
5.
Medicine (Baltimore) ; 99(10): e19124, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32150053

RESUMEN

Many smartphone users experience pain in the thumb/wrist. This pain can be due to certain types of hand injuries as well as inflammation of the extensor pollicis brevis and the abductor pollicis longus tendon sheaths, known as De Quervain tenosynovitis. The objective of this study was to evaluate the association between smartphone addiction and wrist/thumb pain and to determine the severity of the pain, as well as to calculate the prevalence of De Quervain tenosynovitis among medical students at King Abdulaziz University (KAU) in Jeddah.A total of 387 medical students were enrolled. The smartphone addiction scale-short version (SAS-SV) was used to divide participants into the smartphone addict group and non-addict group. Both groups completed the self-administered patient-rated wrist and hand evaluation (PRWHE) questionnaire to evaluate wrist/hand pain. The Finkelstein test was administered to those who reported pain in the thumb/wrist.Two hundred fifty-seven (66.4%) participants were smartphone addicts; 74 (19.1%) had a positive Finkelstein test. There was a significant correlation between smartphone addiction and high PRWHE scores (P = .036).Our study found the prevalence of smartphones addiction among university students to be high (66%), furthermore a correlation between heavy smartphones usage and hand pain was found which indicates that heavy usage of these devices can cause subclinical effects on the human hand.


Asunto(s)
Conducta Adictiva/epidemiología , Conducta Adictiva/fisiopatología , Dolor/etiología , Teléfono Inteligente , Pulgar/fisiopatología , Muñeca/fisiopatología , Estudios Transversales , Enfermedad de De Quervain/epidemiología , Enfermedad de De Quervain/etiología , Humanos , Dolor/epidemiología , Dimensión del Dolor , Prevalencia , Arabia Saudita/epidemiología , Estudiantes de Medicina
6.
Medicine (Baltimore) ; 99(11): e19513, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176099

RESUMEN

A good mobile phone design may increase the productivity of users, as well as their comfort. To achieve mobile users' satisfaction, there is a need to come up with an ideal measurement that would not strain the human's body parts used to control the devices.To investigate the correlation between smartphone and hand anthropometry measurements and the development of hand discomfort and pain.89 Ahlia University students between the ages of 17- and 30-year-old participated in this study. Participants completed a demographic data sheet and had both of their hand dimensions and grip strength measured.A total number of 89 participants were recruited in this study with (57.3%) females and (42.7%) males. 38% have had hand pain recently while 61.8% did not experience any hand pain. There was weak negative correlation between the phone size (r = -0.04, P = .7), hand size (r = -0.08, P = .5), and the hand grip strength (r = -0.03, P = .7) all with the reporting of hand pain. For the phone screen size and the hand lengths (r = 0.22, P = .13) there was weak positive correlation.Mobile phone manufacturers should take into account the users' comfort when designing their phones as this could lead to hand pain and other musculoskeletal problems. Furthermore, hand pain is multifactorial so hand size; phone size and grip strength may be taken into account.


Asunto(s)
Antropometría , Traumatismos de la Mano/etiología , Fuerza de la Mano , Dolor/etiología , Teléfono Inteligente , Adolescente , Adulto , Estudios Transversales , Femenino , Traumatismos de la Mano/fisiopatología , Humanos , Masculino , Dolor/fisiopatología , Dimensión del Dolor , Valores de Referencia , Adulto Joven
7.
N Engl J Med ; 382(12): 1093-1102, 2020 03 19.
Artículo en Inglés | MEDLINE | ID: mdl-32187469

RESUMEN

BACKGROUND: The treatment of chronic sciatica caused by herniation of a lumbar disk has not been well studied in comparison with acute disk herniation. Data are needed on whether diskectomy or a conservative approach is better for sciatica that has persisted for several months. METHODS: In a single-center trial, we randomly assigned patients with sciatica that had lasted for 4 to 12 months and lumbar disk herniation at the L4-L5 or L5-S1 level in a 1:1 ratio to undergo microdiskectomy or to receive 6 months of standardized nonoperative care followed by surgery if needed. Surgery was performed by spine surgeons who used conventional microdiskectomy techniques. The primary outcome was the intensity of leg pain on a visual analogue scale (ranging from 0 to 10, with higher scores indicating more severe pain) at 6 months after enrollment. Secondary outcomes were the score on the Oswestry Disability Index, back and leg pain, and quality-of-life scores at 6 weeks, 3 months, 6 months, and 1 year. RESULTS: From 2010 through 2016, a total of 790 patients were screened; of those patients, 128 were enrolled, with 64 in each group. Among the patients assigned to undergo surgery, the median time from randomization to surgery was 3.1 weeks; of the 64 patients in the nonsurgical group, 22 (34%) crossed over to undergo surgery at a median of 11 months after enrollment. At baseline, the mean score for leg-pain intensity was 7.7 in the surgical group and 8.0 in the nonsurgical group. The primary outcome of the leg-pain intensity score at 6 months was 2.8 in the surgical group and 5.2 in the nonsurgical group (adjusted mean difference, 2.4; 95% confidence interval, 1.4 to 3.4; P<0.001). Secondary outcomes including the score on the Owestry Disability Index and pain at 12 months were in the same direction as the primary outcome. Nine patients had adverse events associated with surgery, and one patient underwent repeat surgery for recurrent disk herniation. CONCLUSIONS: In this single-center trial involving patients with sciatica lasting more than 4 months and caused by lumbar disk herniation, microdiskectomy was superior to nonsurgical care with respect to pain intensity at 6 months of follow-up. (Funded by Physicians' Services Incorporated Foundation; ClinicalTrials.gov number, NCT01335646.).


Asunto(s)
Tratamiento Conservador , Discectomía , Glucocorticoides/administración & dosificación , Desplazamiento del Disco Intervertebral/cirugía , Modalidades de Fisioterapia , Ciática/terapia , Adulto , Tratamiento Conservador/métodos , Estudios Cruzados , Discectomía/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Inyecciones Epidurales , Análisis de Intención de Tratar , Desplazamiento del Disco Intervertebral/complicaciones , Desplazamiento del Disco Intervertebral/tratamiento farmacológico , Masculino , Dolor/etiología , Dimensión del Dolor , Satisfacción del Paciente , Complicaciones Posoperatorias , Calidad de Vida , Ciática/etiología , Ciática/cirugía , Resultado del Tratamiento
8.
Niger Postgrad Med J ; 27(1): 59-62, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32003364

RESUMEN

Emphysematous pyelonephritis (EPN) is a rare, severe necrotising infection of the renal parenchyma and surrounding tissues. It is usually life-threatening and should be promptly treated. Here, we report a clinical case of a 54-year-old male who presented with the left flank pains of 3-week duration. The flank pain was described as dull, constant with associated fever. He was diagnosed with diabetes mellitus (DM) while on admission. A clinical diagnosis of the left pyelonephritis was made. The abdominopelvic computed tomography scan confirmed bilateral EPN by showing a thin film of perinephric fluid (13.2 ml) in the left lower pole. He was managed conservatively with fluid therapy, adequate glycaemic control and intravenous antibiotics with no percutaneous drainage done. This highlights the importance of early initiation of appropriate medical treatment to avoid interventional urological procedures of nephrectomy. It also highlights the importance of clinical suspicion of EPN in patients presenting with symptoms of urinary tract infection and DM.


Asunto(s)
Complicaciones de la Diabetes , Diabetes Mellitus , Enfisema , Pielonefritis , Complicaciones de la Diabetes/diagnóstico , Enfisema/complicaciones , Enfisema/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Nigeria , Dolor/etiología , Pielonefritis/complicaciones , Pielonefritis/diagnóstico
9.
Nephrol Nurs J ; 47(1): 37-44, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32083435

RESUMEN

Chronic kidney disease (CKD) is a major health problem. The purpose of this qualitative study was to describe nephrology nurses' experiences in assessing and managing pain in patients who were receiving maintenance hemodialysis at outpatient units within a tertiary care institution. Semi-structured interviews were conducted with seven nurses, and a thematic analysis was used to analyze data. Themes emerged related to the complexity of pain assessment and management in these patients, who were often elderly. Nurses had to ascertain whether the pain was related to hemodialysis treatment, renal failure, or comorbidities. Nurses described managing pain within the context of the hemodialysis unit, and this required working as a team. Nurses also described the need for a palliative approach in patient care.


Asunto(s)
Enfermería en Nefrología , Personal de Enfermería en Hospital/psicología , Dimensión del Dolor/enfermería , Dolor/enfermería , Diálisis Renal/enfermería , Anciano , Unidades de Hemodiálisis en Hospital , Humanos , Dolor/etiología , Investigación Cualitativa , Diálisis Renal/efectos adversos , Insuficiencia Renal Crónica/terapia
10.
Schmerz ; 34(1): 91-104, 2020 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-32065297

RESUMEN

Osteoporosis is a very common disease all over the world, in which a reduction in bone density can lead to an increased risk of fractures and a diminished physical height. Osteoporosis is also associated with acute and chronic pain, which especially occurs in the back and can significantly reduce the quality of life. To provide sufficient care for affected patients, it is essential to know the particularities of pain management in osteoporosis, such as pharmacological and nonpharmacological treatment options. This article gives a comprehensive review of pain management in osteoporosis and also explains the underlying pathomechanisms, risk factors, and diagnostic procedures.


Asunto(s)
Osteoporosis , Manejo del Dolor , Dolor , Densidad Ósea , Humanos , Osteoporosis/complicaciones , Dolor/etiología , Calidad de Vida , Factores de Riesgo
12.
Internist (Berl) ; 61(3): 261-269, 2020 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-32072188

RESUMEN

Vasculitic neuropathies result from inflammation of the vasa nervorum followed by ischemia and destruction of the peripheral nerve. The inflammation can be systemic or localized, i.e. non-systemic. Systemic vasculitis can be divided into primary and secondary forms. The latter is associated with, e.g. connective tissue diseases, infections, cancer or induced by certain drugs. Around two thirds of patients with systemic vasculitis develop vasculitic neuropathy presenting as characteristic painful, multifocal mononeuropathy of acute onset. The group of non-systemic neuropathies has grown in recent years with the addition of diabetic and non-diabetic lumbosacral radiculoplexus neuropathies, among others. Within the group of connective tissue diseases, other non-vasculitic neuropathies can occur as nerve-entrapment syndromes and sensory ataxic neuropathy. The aim of this article is to present a condensed overview of neuropathies associated with vasculitis and connective tissue diseases and to communicate characteristic clinical symptoms supporting rapid diagnostic and therapeutic procedures.


Asunto(s)
Enfermedades del Tejido Conjuntivo/complicaciones , Enfermedades del Sistema Nervioso Periférico/complicaciones , Polineuropatías/diagnóstico , Vasculitis/complicaciones , Vasculitis/diagnóstico , Humanos , Dolor/diagnóstico , Dolor/etiología , Nervios Periféricos/patología , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Enfermedades del Sistema Nervioso Periférico/terapia , Polineuropatías/terapia , Vasculitis/terapia
13.
Medicine (Baltimore) ; 99(8): e19116, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32080085

RESUMEN

INTRODUCTION: Transitional drainage, which is followed by cholecystectomy plays a key role in the management of acute cholecystitis, especially in high-risk surgical patients. Endoscopic naso-gallbladder drainage (ENGBD) is an alternative to percutaneous transhepatic gallbladder drainage (PTGBD) for patients who need temporary drainage. There is a lack of prospective comparison on the relevant outcomes of the two drainage methods during the period of drainage, especially the subsequent cholecystectomy. METHODS: This is a randomized controlled two-arm non-blind single center trial. Patients with acute cholecystitis undergo emergent or early cholecystectomy and need drainage will be randomly assigned to group PTGBD or ENGBD. Pain score is defined as the primary endpoint, whereas several secondary endpoints, such as the rates of technical success, clinical remission, open conversion of cholecystectomy will be determined to elucidate more detailed differences between two groups. The general feasibility, safety, and quality checks required for high-quality evidence will be adhered to. DISCUSSION: This study would provide the first type A evidence concerning the comparison of ENGBD versus PTGBD in surgically high-risk patients with acute cholecystitis, it will be the first trial designed to determine the impact of two drainage methods on not only peri-drainage but also peri-LC. TRIAL REGISTRATION: NCT03701464. Registered on October 10, 2018.


Asunto(s)
Colecistectomía/métodos , Colecistitis Aguda/cirugía , Endoscopía/métodos , Vesícula Biliar/cirugía , Adulto , Anciano , Colecistitis Aguda/microbiología , Colecistitis Aguda/patología , Colecistostomía/métodos , Drenaje/métodos , Estudios de Factibilidad , Femenino , Vesícula Biliar/microbiología , Vesícula Biliar/patología , Humanos , Masculino , Persona de Mediana Edad , Dolor/etiología , Dolor/fisiopatología , Estudios Prospectivos , Inducción de Remisión/métodos , Resultado del Tratamiento
14.
Mymensingh Med J ; 29(1): 55-59, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31915336

RESUMEN

The purpose of this study is to diagnose Legg-Calve-Perthes disease by computed radiography and Magnetic resonance imaging and accurate staging and correlating the findings of these two modalities. Thirty five (35) patients complaining pain in groins and painful walking, after thorough physical examinations were sent to Department of Radiology & Imaging, Mymensingh Medical College Hospital, Mymensingh, Bangladesh for computed radiography and Magnetic Resonance Imaging examination. This cross sectional study was conducted in the Department of Radiology, Mymensingh Medical College Hospital, Mymensingh, Bangladesh from July 2016 to June 2018. Legg-Calve-Perthes disease among the selected 35 cases were started at the age of 5(2.9%) and age range of the patients were 5-13 years; mean age was (9.63±1.82) years and most of them belonged to 8-10 years of age (51.4%). Patients with Legg-Calve-Perthes disease had been suffering from pain in right and left groins forvarious durations. Maximum duration was 1-2 years (~88.57%). Maximum proportion of diagnosed patients was delivered by normal delivery (60%) and maximum proportion of patients was premature (65.7%). Most of the patients were low birth weight baby (65.7%). Here chi-square test was done and found no significant relationship between delivery mode and birth weight in case of Legg-Calve-Perthesdisease (x²=1.712) (P=0.191). The result of the X-ray and MRI findings by cross table of chi square test found fair inter relationship between two diagnostic instruments. Result found fine difference in staging of the disease between X-ray and MRI findings. It can be said that MRI definitely a better tool for early diagnosis of Legg-Calve-Perthes disease and its staging but X-ray modality can be used. A primary tool for diagnosis and staging of the disease can be done where the MRI facility is not available or cost expensive for patient.


Asunto(s)
Enfermedad de Legg-Calve-Perthes/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Radiografía , Adolescente , Bangladesh , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Masculino , Dolor/etiología
15.
BMC Neurol ; 20(1): 4, 2020 Jan 07.
Artículo en Inglés | MEDLINE | ID: mdl-31910805

RESUMEN

BACKGROUND: Stroke is one of the most common cause of disability worldwide. Pain is common in both stroke survivors and in the general population. Consequences of post-stroke pain (PSP) include reduced quality of life and are important to consider. The aim of the current study was to explore the experience of pain 5 years after stroke, and factors associated with the experience of pain. METHODS: Inclusion criteria were: First ever stroke, treated at Sahlgrenska University Hospital, Sweden, during an 18 months period in 2009-2010, aged 18 years or older. Furthermore, the participants had to respond to a set of questionnaires 5 years post-stroke. Baseline data were collected from medical records and follow-up data from the set of questionnaires. The primary outcome was based on the question Do you experience pain? Predictors and explanatory factors for experiencing more frequent pain were analysed with logistic regression. RESULTS: A total of 281 participants were included. Almost 40% experienced pain to some degree 5 years post-stroke (15% reported pain frequently), and 25% felt that their needs for pain treatment were not met. The participants experiencing more frequent pain reported poorer quality of life, self-perceived health status and recovery post-stroke. Functional dependency at discharge from hospital, experiencing depression at follow up and restricted mobility at follow up were all associated with more frequent pain. CONCLUSION: Pain is common 5 years post-stroke and the treatment is not perceived as optimal. The persons experiencing more frequent pain seem to rate their health and recovery worse than the persons experiencing less frequent pain. Most of the factors associated with more frequent pain were treatable and this emphasize the importance of standardised follow-up care that takes pain into consideration.


Asunto(s)
Dolor , Accidente Cerebrovascular , Anciano , Estudios Transversales , Femenino , Estudios de Seguimiento , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Dolor/epidemiología , Dolor/etiología , Dolor/psicología , Calidad de Vida , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/psicología , Encuestas y Cuestionarios , Suecia/epidemiología
16.
JAMA ; 323(3): 237-247, 2020 01 21.
Artículo en Inglés | MEDLINE | ID: mdl-31961419

RESUMEN

Importance: For patients with painful chronic pancreatitis, surgical treatment is postponed until medical and endoscopic treatment have failed. Observational studies have suggested that earlier surgery could mitigate disease progression, providing better pain control and preserving pancreatic function. Objective: To determine whether early surgery is more effective than the endoscopy-first approach in terms of clinical outcomes. Design, Setting, and Participants: The ESCAPE trial was an unblinded, multicenter, randomized clinical superiority trial involving 30 Dutch hospitals participating in the Dutch Pancreatitis Study Group. From April 2011 until September 2016, a total of 88 patients with chronic pancreatitis, a dilated main pancreatic duct, and who only recently started using prescribed opioids for severe pain (strong opioids for ≤2 months or weak opioids for ≤6 months) were included. The 18-month follow-up period ended in March 2018. Interventions: There were 44 patients randomized to the early surgery group who underwent pancreatic drainage surgery within 6 weeks after randomization and 44 patients randomized to the endoscopy-first approach group who underwent medical treatment, endoscopy including lithotripsy if needed, and surgery if needed. Main Outcomes and Measures: The primary outcome was pain, measured on the Izbicki pain score and integrated over 18 months (range, 0-100 [increasing score indicates more pain severity]). Secondary outcomes were pain relief at the end of follow-up; number of interventions, complications, hospital admissions; pancreatic function; quality of life (measured on the 36-Item Short Form Health Survey [SF-36]); and mortality. Results: Among 88 patients who were randomized (mean age, 52 years; 21 (24%) women), 85 (97%) completed the trial. During 18 months of follow-up, patients in the early surgery group had a lower Izbicki pain score than patients in the group randomized to receive the endoscopy-first approach group (37 vs 49; between-group difference, -12 points [95% CI, -22 to -2]; P = .02). Complete or partial pain relief at end of follow-up was achieved in 23 of 40 patients (58%) in the early surgery vs 16 of 41 (39%)in the endoscopy-first approach group (P = .10). The total number of interventions was lower in the early surgery group (median, 1 vs 3; P < .001). Treatment complications (27% vs 25%), mortality (0% vs 0%), hospital admissions, pancreatic function, and quality of life were not significantly different between early surgery and the endoscopy-first approach. Conclusions and Relevance: Among patients with chronic pancreatitis, early surgery compared with an endoscopy-first approach resulted in lower pain scores when integrated over 18 months. However, further research is needed to assess persistence of differences over time and to replicate the study findings. Trial Registration: ISRCTN Identifier: ISRCTN45877994.


Asunto(s)
Cálculos/terapia , Drenaje , Endoscopía , Litotricia , Manejo del Dolor/métodos , Conductos Pancreáticos/cirugía , Pancreatitis Crónica/terapia , Adulto , Analgésicos Opioides/uso terapéutico , Área Bajo la Curva , Cálculos/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor/etiología , Dimensión del Dolor , Pancreatitis Crónica/complicaciones , Pancreatitis Crónica/cirugía
18.
J Vasc Access ; 21(1): 103-104, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31232211

RESUMEN

Peripherally inserted central catheters are usually inserted in supine patients. What should we do when facing a patient who cannot tolerate this position? In this article, we are describing a particularly difficult patient: not only supine decubitus was intolerable to her but lying on the side was unbearable, too. That is why, to manage a patient who required a central access but could not tolerate the usual position for placing it, we tried to do that in prone position.


Asunto(s)
Neoplasias del Ano/complicaciones , Carcinoma de Células Escamosas/complicaciones , Cateterismo Venoso Central , Cateterismo Periférico , Dolor/etiología , Posicionamiento del Paciente/métodos , Posición Prona , Femenino , Humanos , Persona de Mediana Edad , Posicionamiento del Paciente/efectos adversos
19.
Br J Sports Med ; 54(2): 87-93, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31171514

RESUMEN

OBJECTIVE: To determine the effectiveness of conservative treatment (CT) on pain and function in patients with patellar tendinopathy (PT) compared with minimal intervention (MI) or other invasive intervention, or in addition to decline eccentric squat. METHODS: Searches were performed in MEDLINE, Embase, Cochrane, PEDro, SPORTDiscus, CINAHL and AMED databases. All randomised trials that evaluated CT (any intervention not involving invasive procedures or medication) in individuals with PT were included. Two reviewers screened studies, extracted data and assessed risk of bias of all included studies. Where suitable, meta-analyses were conducted; we assessed certainty of the evidence using GRADE methodology. RESULTS: When compared with MI, CT did not improve pain (weighted mean difference (WMD) -2.6, 95% CI -6.5 to 1.2) or function (WMD 1.8, 95% CI -2.4 to 6.1) in the short-term (up to 3 months) follow-up. When compared with invasive intervention, CT did not improve pain (WMD 0.7, 95% CI -0.1 to 1.4) or function (WMD -6.6, 95% CI -13.3 to 0.2) in the short-term follow-up. No overall effects were found for combined CT (when a conservative intervention was added to decline eccentric squat) on pain (WMD -0.5, 95% CI -1.4 to 0.4) or function (WMD -2.3, 95 % -9.1 to 4.6) at short-term follow-up. Single studies showed an effect on pain with iontophoresis at short-term follow-up (d = 2.42) or dry needling at medium/long-term follow-up (d = 1.17) and function with exercise intervention at medium/long-term follow-up (over 3 months) (d = 0.83). SUMMARY/CONCLUSION: Our estimates of treatment effect have only low to very low certainty evidence to support them. This field of sports medicine/sports physiotherapy urgently needs larger, high-quality studies with pain and function among the potential primary outcomes.


Asunto(s)
Traumatismos en Atletas/complicaciones , Traumatismos en Atletas/terapia , Tratamiento Conservador , Dolor/prevención & control , Tendinopatía/complicaciones , Tendinopatía/terapia , Terapia por Ejercicio , Tratamiento con Ondas de Choque Extracorpóreas , Humanos , Iontoforesis , Dolor/etiología
20.
Br J Sports Med ; 54(5): 263-271, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30728126

RESUMEN

OBJECTIVES: To determine, in people with knee osteoarthritis (KOA): i) the effectiveness of adding hip strengthening exercises to quadriceps exercises and ii) the type of hip strengthening exercise with the greatest evidence for improving pain, function and quality of life. DESIGN: Systematic review with meta-analysis. DATA SOURCES: Medline, Embase, Cochrane, CINAHL and SportDiscus databases were searched from inception to January 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials investigating the effect of adding hip exercises to quadriceps exercises in people with KOA on pain, function and/or quality of life were included. Three subgroups of hip exercises were included: resistance, functional neuromuscular or multimodal exercise. RESULTS: Eight studies were included. Pooled data provide evidence that combined hip and quadriceps exercise is significantly more effective than quadriceps exercise alone for improving walking function (standardised mean difference -1.06, 95% CI -2.01 to -0.12), but not for outcomes of pain (-0.09, 95% CI -0.96 to 0.79), patient-reported function (-0.74, 95% CI -1.56 to 0.08) or stair function (-0.7, 95% CI -1.67 to 0.26). Subgroup analyses reveal that hip resistance exercises are more effective than functional neuromuscular exercises for improving pain (p<0.0001) and patient-reported function (p<0.0001). Multimodal exercise is no more effective than quadriceps strengthening alone for pain (0.13, 95% CI -0.31 to 0.56), patient-reported function (-0.15, 95% CI -0.58 to 0.29) or stair function (0.13, 95% CI -0.3 to 0.57). CONCLUSION: Walking improved after the addition of hip strengthening to quadriceps strengthening in people with KOA. The addition of resistance hip exercises to quadriceps resulted in greater improvements in patient-reported pain and function.


Asunto(s)
Terapia por Ejercicio/métodos , Fuerza Muscular/fisiología , Osteoartritis de la Rodilla/terapia , Dolor/prevención & control , Músculo Cuádriceps/fisiología , Calidad de Vida , Humanos , Osteoartritis de la Rodilla/fisiopatología , Dolor/etiología , Medición de Resultados Informados por el Paciente , Entrenamiento de Resistencia
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