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1.
Bone Joint J ; 103-B(5): 939-945, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33934641

RESUMEN

AIMS: The purpose was to evaluate early clinical, patient-reported, and radiological outcomes of the scapholunate ligament 360° tenodesis (SL 360) technique for treatment of scapholunate (SL) instability. METHODS: We studied the results of nine patients (eight males and one female with a mean age of 44.7 years (26 to 55)) who underwent the SL 360 procedure for reducible SL instability between January 2016 and June 2019, and who were identified from retrospective review of electronic medical records. Final follow-up of any kind was a mean of 33.7 months (12.0 to 51.3). Clinical, radiological, and patient-reported outcome data included visual analogue scale (VAS) for pain, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), Mayo Wrist Score (MWS), and Patient-Rated Wrist Examination (PRWE). Means were analyzed using paired t-test. RESULTS: Before surgery, patients with SL instability were significantly impaired with respect to wrist flexion, extension, and grip strength (mean flexion, 51° (20° to 85°) vs 73° (45° to 90°); mean extension, 46° (15° to 70°) vs 66° (45° to 80°); mean grip strength, 25 kg (20 to 31) vs 50 kg (35 to 68) compared to the unaffected side). The mean SL gap (4.9 mm (2.3 to 7.3) vs 2.1 mm (1.6 to 2.9)) and mean SL angle (71° (59° to 105°) vs 50° (38° to 64°) were also significantly greater in the affected wrist. At final follow-up, there was mean improvement regarding clinical, radiological, and functional outcomes comparing preoperative to final postoperative values for the VAS for pain scale, QuickDASH, MWS, PRWE, and SL gap and SL angle. CONCLUSION: In our small series, the SL 360 procedure for reducible SL instability has favourable early clinical, patient-reported, and radiological outcomes at a mean of 33.7 months (12.0 to 51.3). The suture tape and tendon construct confers robust stability, permitting earlier mobilization without the inherent disadvantages of Kirschner wire stabilization. Cite this article: Bone Joint J 2021;103-B(5):939-945.


Asunto(s)
Inestabilidad de la Articulación/cirugía , Tenodesis/métodos , Articulación de la Muñeca/cirugía , Adulto , Evaluación de la Discapacidad , Femenino , Humanos , Inestabilidad de la Articulación/diagnóstico por imagen , Hueso Semilunar , Masculino , Persona de Mediana Edad , Medición de Resultados Informados por el Paciente , Rango del Movimiento Articular , Estudios Retrospectivos , Hueso Escafoides , Articulación de la Muñeca/diagnóstico por imagen
2.
Bone Joint J ; 103-B(5): 951-957, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33934646

RESUMEN

AIMS: The aim of this study was to define the complications and long-term outcome following adolescent mid-shaft clavicular fracture. METHODS: We retrospectively reviewed a consecutive series of 677 adolescent fractures in 671 patients presenting to our region (age 13 to 17 years) over a ten-year period (2009 to 2019). Long-term patient-reported outcomes (abbreviated version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score and EuroQol five-dimension three-level (EQ-5D-3L) quality of life score) were undertaken at a mean of 6.4 years (1.2 to 11.3) following injury in severely displaced mid-shaft fractures (Edinburgh 2B) and angulated mid-shaft fractures (Edinburgh 2A2) at a minimum of one year post-injury. The median patient age was 14.8 years (interquartile range (IQR) 14.0 to 15.7) and 89% were male (n = 594/671). RESULTS: The majority of fractures were mid-shaft (n = 606) with angulation (Edinburgh 2A2, n = 241/606, 39.8%) or displacement (Edinburgh 2B1/2, n = 263/606, 43.4%). Only 7% of the displaced mid-shaft fractures underwent acute fixation (n = 18/263). The incidence of refracture over ten years following nonoperative management of mid-shaft fractures was 3.2% (n = 19/588) and all united without surgery. Fracture type, severity of angulation, or displacement were not associated with refracture. One nonunion occurred following nonoperative management in a displaced mid-shaft fracture (0.4%, n = 1/245). Of the angulated fractures, 61 had angulation > 30°, of which 68.9% (n = 42/61) completed outcome scores with a median QuickDASH of 0.0 (IQR 0.0 to 0.6), EQ-5D-3L 1.0 (1.0 to 1.0), and 98% satisfaction with shoulder function. For the displaced fractures, 127 had displacement beyond one cortical width of bone for which completed outcome scores were provided in 72.4% (n = 92/127). Of these 15 had undergone acute fixation. Following nonoperative treatment, the median QuickDASH was 0.0 (IQR 0.0 to 2.3), EQ-5D-3L 1.0 (1.0 to 1.0), and satisfaction with shoulder function was 95%. There were no significant differences in the patients' demography or functional outcomes between operative and nonoperative treatments. CONCLUSION: Nonoperative management of adolescent mid-shaft clavicle fractures results in excellent functional outcomes at long-term follow-up. Nonunion is exceptionally rare following nonoperative management and the relative indications for surgical intervention in adults do not appear to be applicable to adolescents. Cite this article: Bone Joint J 2021;103-B(5):951-957.


Asunto(s)
Clavícula/lesiones , Fijación de Fractura/métodos , Fracturas Óseas/terapia , Fracturas no Consolidadas/terapia , Adolescente , Evaluación de la Discapacidad , Femenino , Estudios de Seguimiento , Curación de Fractura , Humanos , Masculino , Medición de Resultados Informados por el Paciente , Complicaciones Posoperatorias , Calidad de Vida , Estudios Retrospectivos
3.
Glob Health Action ; 14(1): 1903214, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-33904370

RESUMEN

If Sustainable Developmental Goal 3 and Universal Health Coverage are to be achieved, functioning is a third health indicator which must be assessed and integrated into global health population-based metrics alongside mortality and morbidity. In this paper, we define functioning according to the International Classification of Functioning, Disability and Health (ICF) and present why functioning is important to measure, especially when considering the need for, and outcome of, rehabilitation and assistive technology. We discuss examples of tools that measure components of functioning through clinical assessment and self-report methodologies, and present the development of a comprehensive population level tool which aligns with the ICF and combines self-report and clinical measurement methods to measure functioning and the need for rehabilitation and AT. Throughout the paper a survivor of Coronavirus 2019 (COVID-19) is given as an example to illustrate functioning according to the ICF and how access to the interventions of rehabilitation and assistive technology might be of benefit to improve and optimise his/her functioning. We argue that the Global Health community must take action and ensure that the measurement of functioning is well established, accepted and integrated as the third health indicator following the COVID-19 pandemic.


Asunto(s)
Coronavirus , Personas con Discapacidad , Evaluación de la Discapacidad , Femenino , Objetivos , Humanos , Masculino , Pandemias , Sobrevivientes , Desarrollo Sostenible , Cobertura Universal del Seguro de Salud
4.
Epidemiol Mikrobiol Imunol ; 70(1): 26-31, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33853335

RESUMEN

The present paper analyses the development of invalidity in people living with HIV over a nine-year period from 2010 to 2018. The disability assessment criteria currently in place were introduced in 2010 and are legally regulated. The paper draws from the Czech Social Security Administration data to analyse the incidence of invalidity as a result of HIV infection compared to other diseases in the Czech population. The authors illustrate the invalidity assessment criteria with a case study. In the final part, updating the current assessment criteria is recommended, also because of the envisaged ICD-11 implementation in the Czech Republic.


Asunto(s)
Personas con Discapacidad , Infecciones por VIH , República Checa/epidemiología , Evaluación de la Discapacidad , Infecciones por VIH/epidemiología , Humanos , Incidencia
5.
Bone Joint J ; 103-B(4): 762-768, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33789482

RESUMEN

AIMS: To compare the functionality of adults with displaced mid-shaft clavicular fractures treated either operatively or nonoperatively and to compare the relative risk of nonunion and reoperation between the two groups. METHODS: Based on specific eligibility criteria, 120 adults (median age 37.5 years (interquartile range (18 to 61)) and 84% males (n = 101)) diagnosed with an acute displaced mid-shaft fracture were recruited, and randomized to either the operative (n = 60) or nonoperative (n = 60) treatment group. This randomized controlled, partially blinded trial followed patients for 12 months following initial treatment. Functionality was assessed by the Constant score (CS) (assessor blinded to treatment) and Disability of the Arm, Shoulder and Hand (DASH) score. Clinical and radiological evaluation, and review of patient files for complications and reoperations, were added as secondary outcomes. RESULTS: At 12 months, 87.5% of patients (n = 105) were available for analysis. The two groups were well balanced based on demographic and fracture-related characteristics. At six weeks of follow-up a significant difference in DASH score (p < 0.001) was found in favour of operative treatment. The functionality at 12 months of follow-up based on CS and DASH was excellent in both groups (CS > 90 points and DASH < 10 points) with no significant difference (p = 0.277 for DASH and p = 0.184 for CS) between the two groups. The risk of symptomatic nonunion was significantly higher in the nonoperative group (p = 0.014), with a relative risk of 9.47 (95% confidence interval (CI) 1.26 to 71.53) in this group compared to the operative group. The number-needed-to-treat to avoid one symptomatic nonunion was 6.2. Initial treatment and age were factors significantly associated with nonunion in a logistic analysis. There were 26% in both groups (n = 14 in operative group and n = 15 in nonoperative group) who required secondary surgery, with most indications in the nonoperative group mandatory due to nonunion compared to most relative indications in the operative group requiring intervention due to implant irritation. CONCLUSION: Superiority was not identified with either an all-operative or all-nonoperative approach. The functionality at short term (within six weeks) seems igreater following operative treatment but was not found at one year. The risk of nonunion is significantly higher with nonoperative treatment. However, an all-operative approach to lower the nonunion risk may result in unnecessary surgery and is not recommended. Cite this article: Bone Joint J 2021;103-B(4):762-768.


Asunto(s)
Clavícula/lesiones , Fijación de Fractura/métodos , Fracturas Óseas/terapia , Fracturas no Consolidadas/terapia , Adolescente , Adulto , Dinamarca , Evaluación de la Discapacidad , Femenino , Curación de Fractura , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Recuperación de la Función , Reoperación
6.
Occup Ther Int ; 2021: 8874953, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33824630

RESUMEN

Purpose: This study is aimed at validating the A-ONE scale in an Italian population with Central Nervous System (CNS) dysfunction. Material and Methods. Between May and November 2018, people aged between 60 and 90 with CNS dysfunction were recruited in a hospital in Rome, Italy. Patients were observed and evaluated during the activities of daily living. Internal consistency and reliability were evaluated with Cronbach's coefficient alpha and intraclass correlation coefficient, respectively. As measured with Pearson's correlation coefficient, the validity was examined comparing results of the A-ONE with the Barthel index. Responsiveness was evaluated 30 days after the first administration. Results: A total of 70 people having a diagnosis of neurological disorders were evaluated. The internal consistency showed Cronbach's coefficient alpha ranging from 0.634 to 0.959. The measurement of reliability varied from 0.984 to 0.997 for intrarater and from 0.979 to 0.998 for interrater. Pearson's correlation coefficient between the A-ONE and the Barthel index and the responsiveness showed statistically significant values (p < 0.01). Conclusions: The present study provides preliminary evidence of reliability, validity, and responsiveness of the A-ONE when using elderly people with CNS dysfunction.


Asunto(s)
Actividades Cotidianas , Trastornos Cerebrovasculares/rehabilitación , Pruebas Neuropsicológicas/normas , Psicometría/estadística & datos numéricos , Encuestas y Cuestionarios/normas , Anciano , Anciano de 80 o más Años , Estudios Transversales , Evaluación de la Discapacidad , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Análisis y Desempeño de Tareas
7.
Artículo en Inglés | MEDLINE | ID: mdl-33810298

RESUMEN

The purpose of this study is to understand the functional status distribution and to explore the factors associated with changes in functional status and social participation in people with depression using two-year follow-up data. Subjects were selected from the Taiwan Databank of Persons with Disabilities (TDPD) if they had an evaluation date between July 2012 and 31 December 2017. We used data for 1138 individuals with multiple evaluation records and who were diagnosed with depression. The WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) was the primary functional status measure. Other factors selected from the TDPD included social demographic data, living situation, employment status, economic status, and educational level. The results show scores in all dimensions of the WHODAS 2.0 declined over two years, especially in the domains of cognition, household activities, social participation, and total WHODAS 2.0 score. Aging groups showed poor recovery in cognition, getting along with others, and household activities. People living in suburban areas showed poorer recovery than people living in rural and urban areas in cognition, self-care, and general function (total score of WHODAS 2.0). Employment was also strongly associated with functional recovery in household activities, social participation, and general function. The original scores for cognition and getting along with others showed a significant negative relationship with social participation improvement. Our results can be used by policy makers to provide resources and conduct investigations, and by clinicians when making rehabilitation plans.


Asunto(s)
Depresión , Personas con Discapacidad , Actividades Cotidianas , Depresión/epidemiología , Evaluación de la Discapacidad , Estudios de Seguimiento , Humanos , Taiwán/epidemiología
8.
Washington, D.C.; PAHO; 2021-04-26. (PAHO/NMH/CRB/21-0003).
en Inglés | PAHO-IRIS | ID: phr-53821

RESUMEN

The Pan American Health Organization and the International Legal Consortium at the Campaign for Tobacco-Free Kids, with support from the European Union, held the subregional workshop The Use of Law to Address Noncommunicable Diseases in the Caribbean on 3–5 March 2020 in Miami, the United States of America. The three-day workshop sought to build capacity to advance the use of law and regulations to address noncommunicable diseases (NCDs) and their risk factors in the Caribbean. NCDs and their four main risk factors (tobacco use, physical inactivity, the harmful use of alcohol, and unhealthy diets) remain leading causes of mortality, morbidity, and disability in the Caribbean. However, this subregion lags in terms of the implementation of NCD risk factor policies that require regulatory action. In this context, the use of law has a central role to play. Therefore, the workshop familiarized participants with the best practices in the use of law to regulate and control NCDs and their risk factors. This Subregional Workshop Report reflects the contributions made during the technical presentations and question and answer segments, round-table discussions, plenary discussions, and working groups. It highlights the important connections made across NCD risk factors, particularly in relation to marketing regulations and labelling requirements. Finally, the Subregional Workshop Report reflects the set of strategic actions to advance the enactment, implementation, and enforcement of NCD risk factor policies through laws and regulations in the Caribbean. These include the establishment of a Caribbean Public Health Law Forum for continued communication, collaboration, and engagement on health and law matters.


Asunto(s)
Enfermedad Crónica , Factores de Riesgo , Salud Mental , Diabetes Mellitus , Programas y Políticas de Nutrición y Alimentación , Mortalidad , Indicadores de Morbimortalidad , Evaluación de la Discapacidad , Programas Nacionales de Salud , Cese del Uso de Tabaco , Etiquetado de Productos , Región del Caribe , Consumo de Bebidas Alcohólicas , Obesidad
9.
Am Fam Physician ; 103(9): 539-546, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33929170

RESUMEN

The preparticipation physical evaluation (PPE) is a common reason for young athletes to see a primary care physician. An annual PPE is required by most state high school athletic associations for participation in school-based sports, although there is limited evidence to support its effectiveness for detecting conditions that predispose athletes to injury or illness. In 2019, the American Academy of Pediatrics, with representatives from the American Academy of Family Physicians and other organizations, published updated PPE recommendations (PPE5). According to the guideline, the general goals of the PPE are determining general physical and psychological health; evaluating for life-threatening or disabling conditions, including risk of sudden cardiac arrest and other conditions that may predispose the athlete to illness or injury; and serving as an entry point into the health care system for those without a medical home or primary care physician. The guideline recommends that the evaluation take place in the physician's office rather than in a group setting. The PPE should include a structured physical examination that focuses on the cardiovascular, musculoskeletal, and neurologic systems. Screening for depression, anxiety disorders, and attention-deficit/hyperactivity disorder is also recommended. Clinicians should recognize any findings suggestive of the relative energy deficiency in sport syndrome. Additional consideration is required to address the needs and concerns of transgender athletes and athletes with physical and intellectual disabilities. Finally, guidelines have been published regarding return to play for athletes who have had COVID-19.


Asunto(s)
/epidemiología , Medicina Familiar y Comunitaria/normas , Tamizaje Masivo , Pediatría/normas , Examen Físico , Medición de Riesgo , Medicina Deportiva/normas , Traumatismos en Atletas/prevención & control , Niño , Evaluación de la Discapacidad , Medicina Basada en la Evidencia , Estado de Salud , Humanos , Tamizaje Masivo/métodos , Tamizaje Masivo/organización & administración , Salud Mental , Examen Físico/métodos , Examen Físico/normas , Guías de Práctica Clínica como Asunto , Volver al Deporte/normas , Volver al Deporte/tendencias , Medición de Riesgo/métodos , Medición de Riesgo/normas , Factores de Riesgo , Estados Unidos
10.
Artículo en Inglés | MEDLINE | ID: mdl-33668099

RESUMEN

(1) Objectives: The evaluation of dizzy patients is difficult due to nonspecific symptoms that require a multi-specialist approach. The Dizziness Handicap Inventory (DHI) is widely used in the assessment of dizziness-related disability, but its clinical efficacy needs further expansion. The aim of this study was to identify the subscales of DHI that may correlate with some vestibular or nonvestibular dysfunctions. (2) Material and methods: This observational study included 343 dizzy patients with one of the following clinical conditions: Vestibular impairment noncompensated or compensated, central or bilateral, benign paroxysmal positional vertigo (BPPV), migraine and psychogenic dizziness. Principal component analysis was used to examine the factorial structure of the questionnaire. (3) Results: The DHI questionnaire total scoring and its vestibular subscale distinguished between patients with compensated and uncompensated vestibular dysfunction with positive predictive values of 76% and 79%, respectively. The DHI items composing the F3 (positional) subscale revealed the highest scoring in the BPPV group with 75% sensitivity and 92% negative predictive value (NPV) in reference to Dix-Hallpike tests. The DHI total score and the subscales scores correlated with anxiety-depression, and the highest correlation coefficients were calculated for vestibular (F2 0.56) and anxiety (F5 0.51) subscales. (4) Conclusions: Our analysis revealed that the DHI vestibular subscale distinguishes between patients with compensated and uncompensated vestibular dysfunction. The positional subscale showed the highest scoring in the BPPV group with high sensitivity and low specificity of the test. The DHI is highly correlated with patients' psychological status.


Asunto(s)
Personas con Discapacidad , Trastornos Migrañosos , Vértigo Posicional Paroxístico Benigno , Evaluación de la Discapacidad , Mareo/diagnóstico , Humanos , Encuestas y Cuestionarios
11.
J Stroke Cerebrovasc Dis ; 30(5): 105681, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33652345

RESUMEN

BACKGROUND: A third to half of recurrent stroke occur while on antiplatelet therapy, but no study has explored factors relating to prognosis of recurrent ischemic stroke. This study aimed to clarify the risk factors to determine the clinical outcome of recurrent ischemic stroke. METHODS: A total of 1,333 consecutive acute ischemic stroke patients (first n = 492, recurrent n = 841) were enrolled. We explored factors influencing the modified Rankin Scales (mRS) at discharge that included platelet aggregability, preceding medicines, and well-known risks of biochemical data using Chi-square test or Fisher's exact probability test. RESULTS: As to preceding medicines, the proportion of patients who were functionally independent (mRS 0-2) at discharge was higher in preceding P2Y12 inhibitor that suppressed ADP- and collagen-induced macro-aggregation of platelet and Xa inhibitor or warfarin in cardioembolic stroke, but lower in P2Y12 inhibitor and Xa inhibitor or warfarin in lacunar stroke compared with no medicine. Regardless of LDL-cholesterol and HA1c, the mRS at discharge ≤ 2 was increased in the third tertile of serum albumin and body mass index (BMI) in atherothrombotic stroke; serum albumin and high-density lipoprotein cholesterol (HDL-C) in lacunar stroke; and serum albumin, HDL-C and BMI in cardioembolic stroke. Logistic regression analysis identified the following independent predictors for clinical outcome: serum albumin, HDL-C, BMI, and preceding Xa inhibitor and P2Y12 inhibitor. CONCLUSION: Regardless of well-known risk factors such as diabetes and high LDL-C, preceding treatment for Xa inhibitor or P2Y12 inhibitor, serum albumin, HDL-C, and BMI were associated with prognosis in recurrent ischemic stroke.


Asunto(s)
Índice de Masa Corporal , Inhibidores del Factor Xa/uso terapéutico , Antagonistas del Receptor Purinérgico P2Y/uso terapéutico , Albúmina Sérica Humana/análisis , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , HDL-Colesterol/sangre , Evaluación de la Discapacidad , Femenino , Humanos , /diagnóstico , Masculino , Persona de Mediana Edad , Limitación de la Movilidad , Pronóstico , Recurrencia , Medición de Riesgo , Factores de Riesgo
12.
J Stroke Cerebrovasc Dis ; 30(5): 105687, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33657521

RESUMEN

OBJECTIVES: Whether elderly patients with adverse comorbidities or strong vascular meandering benefit from mechanical thrombectomy to the same degree as patients who participated in the pivotal randomized controlled trials on this procedure (MR CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME, REVASCAT, DAWN, and DEFUSE 3) remains unknown. We aimed to investigate the predictors of reperfusion and 90-day functional outcome using real-world clinical data, without excluding elderly patients with adverse comorbidities or patients in whom vascular access could not be achieved. MATERIALS AND METHODS: We retrospectively reviewed consecutive patients with acute ischemic stroke who underwent or in whom mechanical thrombectomy was attempted at Japanese Red Cross Matsue Hospital from April 2015 to June 2020. RESULTS: Altogether, 111 mechanical thrombectomies in 111 patients (average age 77.2 years) were attempted for acute ischemic stroke. Vascular access was not achieved in 8 (7.2%) cases. In the multivariable analysis, age ≥85 years (odd ratio [OR] 0.191, 95% confidence interval [CI] 0.057-0.641, p = 0.007) and presence of adverse comorbidities (OR 0.265, 95% CI 0.090-0.659, p = 0.016) were associated with failed reperfusion. The diffusion-weighted imaging (DWI)-ASPECT score ≥6 (OR 4.650, 95% CI 1.610-13.40, p = 0.005) was associated with good 90-day functional outcomes. Presence of adverse comorbidities was not a predictor, but it had a relatively strong correlation with poor functional outcome. CONCLUSIONS: Mechanical thrombectomy in elderly patients should be considered very carefully if they are aged ≥85 years, have low DWI-ASPECT score and have clear evidence of pre-existing adverse comorbidities.


Asunto(s)
Circulación Cerebrovascular , Procedimientos Endovasculares , Trombectomía , Grado de Desobstrucción Vascular , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Toma de Decisiones Clínicas , Comorbilidad , Imagen de Difusión por Resonancia Magnética , Evaluación de la Discapacidad , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Femenino , Humanos , /fisiopatología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Stents , Trombectomía/efectos adversos , Trombectomía/instrumentación , Factores de Tiempo , Resultado del Tratamiento
13.
J Stroke Cerebrovasc Dis ; 30(5): 105677, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33677312

RESUMEN

BACKGROUND: Dual antiplatelet therapy (DAT) is a therapeutic option for patients with minor ischemic stroke (IS) or transient ischemic attack (TIA). No study has evaluated the incidence of early bleeding in patients with moderate to major ischemic stroke. The current study aimed to analyze both the frequency of early bleeding and hospital morbidity related to DAT for either acute IS or TIA regardless of admission National Institute of Health Stroke Scale (NIHSS) score. METHODS: This was a retrospective analysis based on data collected from a prospective data bank of a single center. We included patients who underwent DAT in the first 24 hours of symptom onset with a loading dose (aspirin 300 mg + clopidogrel 300 mg) on the first day, followed by a maintenance dose (aspirin 100 mg + clopidogrel 75 mg). We analyzed intracranial and/or extracranial hemorrhage that had occurred during the hospital admission, symptomatic bleeding, modified Rankin Scale (mRS) score at discharge, and death rates as outcomes. RESULTS: Of the 119 patients analyzed, 94 (79 %) had IS and 25 (21 %) had TIA. Hemorrhage occurred in 11 (9.2 %) and four (3.4 %) patients with TIA or NIHSS ≤ 3, respectively, although none were symptomatic. Patients with bleeding as a complication had higher admission NIHSS [4 (3-7) vs. 2 (1-4), p = 0.044] and had higher mRS at discharge (mRS 2 [1-5] vs. mRS 1 [0-2], p = 0.008). These findings did not indicate increased mortality, as one (9 %) patient died from bleeding and two (1.8 %) patients died without bleeding (p = 0.254). CONCLUSION: DAT seems to be a safe therapy in patients regardless of admission NIHSS if started within the first 24 h after symptom onset because only 1.6 % of patients had symptomatic bleeding.


Asunto(s)
Aspirina/efectos adversos , Clopidogrel/efectos adversos , Evaluación de la Discapacidad , Terapia Antiplaquetaria Doble/efectos adversos , Hemorragias Intracraneales/inducido químicamente , Ataque Isquémico Transitorio/tratamiento farmacológico , Admisión del Paciente , Inhibidores de Agregación Plaquetaria/efectos adversos , Accidente Cerebrovascular/tratamiento farmacológico , Tiempo de Tratamiento , Anciano , Aspirina/administración & dosificación , Brasil/epidemiología , Clopidogrel/administración & dosificación , Bases de Datos Factuales , Esquema de Medicación , Terapia Antiplaquetaria Doble/mortalidad , Femenino , Humanos , Incidencia , Hemorragias Intracraneales/diagnóstico , Hemorragias Intracraneales/mortalidad , Ataque Isquémico Transitorio/diagnóstico , Ataque Isquémico Transitorio/mortalidad , Masculino , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/administración & dosificación , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/mortalidad , Factores de Tiempo , Resultado del Tratamiento
14.
J Stroke Cerebrovasc Dis ; 30(5): 105661, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33684710

RESUMEN

BACKGROUND AND PURPOSE: Stroke outcome data in Uganda is lacking. The objective of this study was to capture 30-day mortality outcomes in patients presenting with acute and subacute stroke to Mbarara Regional Referral Hospital (MRRH) in Uganda. METHODS: A prospective study enrolling consecutive adults presenting to MRRH with abrupt onset of focal neurologic deficits suspicious for stroke, from August 2014 to March 2015. All patients had head computed tomography (CT) confirmation of ischemic or hemorrhagic stroke. Data was collected on mortality, morbidity, risk factors, and imaging characteristics. RESULTS: Investigators screened 134 potential subjects and enrolled 108 patients. Sixty-two percent had ischemic and 38% hemorrhagic stroke. The mean age of all patients was 62.5 (SD 17.4), and 52% were female. More patients had hypertension in the hemorrhagic stroke group than in the ischemic stroke group (53% vs. 32%, p = 0.0376). Thirty-day mortality was 38.1% (p = 0.0472), and significant risk factors were National Institutes of Health Stroke Scale (NIHSS) score, female sex, anemia, and HIV infection. A one unit increase of the NIHSS on admission increased the risk of death at 30 days by 6%. Patients with hemorrhagic stroke had statistically higher NIHSS scores (p = 0.0408) on admission compared to patients with ischemic stroke, and also had statistically higher Modified Rankin Scale (mRS) scores at discharge (p = 0.0063), and mRS score change from baseline (p = 0.04). CONCLUSIONS: Our study highlights an overall 30-day stroke mortality of 38.1% in southwestern Uganda, and identifies NIHSS at admission, female sex, anemia, and HIV infection as predictors of mortality.


Asunto(s)
/mortalidad , /mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Anemia/mortalidad , Comorbilidad , Evaluación de la Discapacidad , Femenino , Infecciones por VIH/mortalidad , /terapia , Hospitalización , Humanos , /terapia , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Factores Sexuales , Factores de Tiempo , Tomografía Computarizada por Rayos X , Uganda/epidemiología , Adulto Joven
15.
Bone Joint J ; 103-B(3): 462-468, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33641427

RESUMEN

AIMS: Minimally invasive fixation of pelvic fragility fractures is recommended to reduce pain and allow early mobilization. The purpose of this study was to evaluate the outcome of two different stabilization techniques in bilateral fragility fractures of the sacrum (BFFS). METHODS: A non-randomized, prospective study was carried out in a level 1 trauma centre. BFFS in 61 patients (mean age 80 years (SD 10); four male, 57 female) were treated surgically with bisegmental transsacral stablization (BTS; n = 41) versus spinopelvic fixation (SP; n = 20). Postoperative full weightbearing was allowed. The outcome was evaluated at two timepoints: discharge from inpatient treatment (TP1; Fitbit tracking, Zebris stance analysis), and ≥ six months (TP2; Fitbit tracking, Zebris analysis, based on modified Oswestry Disability Index (ODI), Majeed Score (MS), and the 12-Item Short Form Survey 12 (SF-12). Fracture healing was assessed by CT. The primary outcome parameter of functional recovery was the per-day step count; the secondary parameter was the subjective outcome assessed by questionnaires. RESULTS: Overall, no baseline differences were observed between the BTS and SP cohorts. In total, 58 (BTS = 19; SP = 39) and 37 patients (BTS = 14; SP = 23) could be recruited at TP1 and TP2, respectively. Mean steps per day at TP1 were median 308 (248 to 434) in the BTS group and 254 (196 to 446) in the SP group. At TP2, median steps per day were 3,759 (2,551 to 3,926) in the BTS group and 3,191 (2,872 to 3,679) in the SP group, each with no significant difference. A significant improvement was observed in each group (p < 0.001) between timepoints. BTS patients obtained better results than SP patients in ODI (p < 0.030), MS (p = 0.007), and SF-12 physical status (p = 0.006). In all cases, CT showed sufficient fracture healing of the posterior ring. CONCLUSION: Both groups showed significant outcome improvement and sufficient fracture healing. Both techniques can be recommended for BFFS, although BTS was superior with respect to subjective outcome. Step-count tracking represents a reliable method to evaluate the mobility level. Cite this article: Bone Joint J 2021;103-B(3):462-468.


Asunto(s)
Fijación Interna de Fracturas/métodos , Sacro , Fracturas de la Columna Vertebral/cirugía , Anciano de 80 o más Años , Tornillos Óseos , Estudios de Casos y Controles , Evaluación de la Discapacidad , Femenino , Fijación Interna de Fracturas/instrumentación , Curación de Fractura , Humanos , Masculino , Estudios Prospectivos , Fracturas de la Columna Vertebral/diagnóstico por imagen , Fracturas de la Columna Vertebral/fisiopatología , Soporte de Peso
16.
Bone Joint J ; 103-B(3): 542-546, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33641429

RESUMEN

AIMS: The aim of this study was to investigate the efficacy of coccygectomy in patients with persistent coccydynia and coccygeal instability. METHODS: The Danish National Spine Registry, DaneSpine, was used to identify 134 consecutive patients who underwent surgery, performed by a single surgeon between 2011 and 2019. Routine demographic data, surgical variables, and patient-reported outcomes, including a visual analogue scale (VAS) (0 to 100) for pain, Oswestry Disability Index (ODI), EuroQol five-dimension questionnaire (EQ-5D), and the Physical Component Score (PCS) and Mental Component Score (MCS) of the 36-Item Short-Form Health Survey questionnaire (SF-36) were collected at baseline and one-year postoperatively. RESULTS: A total of 112 (84%) patients with a minimum follow-up of one year had data available for analysis. Their mean age was 41.9 years, and 15 (13%) were males. At 12 months postoperatively, there were statistically significant improvements (p < 0.001) from baseline for the mean VAS for pain (70.99 to 35.34), EQ-5D (0.52 to 0.75), ODI (31.84 to 18.00), and SF-36 PCS (38.17 to 44.74). A total of 78 patients (70%) were satisfied with the outcome of treatment. CONCLUSION: Patients with persistent coccydynia and coccygeal instability resistant to nonoperative treatment may benefit from coccygectomy. Cite this article: Bone Joint J 2021;103-B(3):542-546.


Asunto(s)
Cóccix/fisiopatología , Cóccix/cirugía , Dolor de la Región Lumbar/fisiopatología , Dolor de la Región Lumbar/cirugía , Adolescente , Adulto , Anciano , Dinamarca , Evaluación de la Discapacidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Manejo del Dolor/métodos , Dimensión del Dolor , Sistema de Registros , Encuestas y Cuestionarios
17.
Bull Cancer ; 108(4): 352-358, 2021 Apr.
Artículo en Francés | MEDLINE | ID: mdl-33678407

RESUMEN

In a few situations, the consequences secondary to a carcinological pathology require an assessment of damages for compensatory purposes. This is particularly the case when liable parties have been found to be at cause of the disease: occupational pathologies in the case of inexcusable employer's fault, exposure to a radioactive risk, for example in the context of full compensation for damages suffered by the victims of nuclear experiments performed by France, or lastly, in the after-effects of late diagnosis. This article does not discuss the imputability of cancer pathologies to an event, but it proposes an adaptation of methods for assessing damages, in an attempt to provide full compensation for damages.


Asunto(s)
Compensación y Reparación/legislación & jurisprudencia , Responsabilidad Legal , Neoplasias , Enfermedades Profesionales , Causalidad , Evaluación de la Discapacidad , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Estética , Francia , Experimentación Humana/legislación & jurisprudencia , Humanos , Discapacidades para el Aprendizaje/etiología , Responsabilidad Legal/economía , Neoplasias/economía , Neoplasias/etiología , Neoplasias/psicología , Neoplasias/terapia , Neoplasias Inducidas por Radiación/economía , Neoplasias Inducidas por Radiación/etiología , Enfermedades Profesionales/economía , Enfermedades Profesionales/etiología , Dolor , Complicaciones Posoperatorias , Traumatismos por Radiación/economía , Traumatismos por Radiación/etiología , Radioterapia/efectos adversos , Disfunciones Sexuales Fisiológicas/etiología , Responsabilidad Social
18.
Medicine (Baltimore) ; 100(8): e23718, 2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-33663038

RESUMEN

ABSTRACT: Pain as a result of cervical radiculopathy (CR) can be widespread, nondermatomal and individually specific, but the association between pain extent and other clinical features has never been explored. The objective of this study is to investigate whether pain extent relates to clinical variables including pain intensity in addition to health indicators including disability, general health, depression, somatic anxiety, coping strategies or self-efficacy.An observational cohort study was conducted. Participants were recruited from 4 hospital spinal centres in Sweden. Pain extent was quantified from the pain drawings of 190 individuals with cervical disc disease, verified with magnetic resonance imaging (MRI) and compatible with clinical findings (examined by a neurosurgeon), that show cervical nerve root compression. Pain extent was evaluated in relation to neck pain, arm pain, and headache intensity. Multiple linear regression analysis were then used to verify whether pain extent was associated with other health indicators including disability, health-related quality of life, depression, somatic anxiety, coping strategies and self-efficacy.Pain extent was directly related to neck, arm and headache pain intensity (all P < .01). Multiple linear regression revealed that pain extent was significantly associated only to the level of perceived disability (P < .01).Increased pain extent in people with CR is associated with higher headache, neck and arm pain intensity, and disability but not measures of general health, depression, somatic anxiety, coping strategies or self-efficacy.


Asunto(s)
Evaluación de la Discapacidad , Estado de Salud , Dolor/etiología , Dolor/psicología , Radiculopatía/complicaciones , Adaptación Psicológica , Adulto , Factores de Edad , Anciano , Vértebras Cervicales , Depresión/etiología , Personas con Discapacidad , Ejercicio Físico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Calidad de Vida , Autoeficacia , Factores Sexuales , Factores Socioeconómicos , Suecia , Evaluación de Capacidad de Trabajo , Adulto Joven
19.
Medicine (Baltimore) ; 100(12): e25122, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761677

RESUMEN

ABSTRACT: Golimumab is a fully human monoclonal antibody against tumor necrosis factor (TNF) approved for the treatment of ulcerative colitis and not for Crohn disease (CD). Many CD patients experience primary, secondary failure, or intolerance to other TNF inhibitors (TNFi) approved in Italy for CD (adalimumab and infliximab). Spondyloarthritis (SpA) may be associated with CD (enteropathic, ESpA) in up to 50% of patients requiring a multidisciplinary and tailored approach. However, only few data from literature and no formal trials determined the efficacy and safety of golimumab in ESpA patients. We performed a case series on 12 patients affected by active CD and active ESpA were failure or intolerant to previous TNFi approved in Italy for both SpA and CD, infliximab and adalimumab. Golimumab was administered following rheumatologic dosage (subcutaneous 50 mg monthly; 100 mg monthly for patients ≥100 kg). Gastrointestinal and rheumatologic disease activity was evaluated with a follow-up of 2 years. A total of 9 patients were followed for 2 years of golimumab treatment. CD clinical activity ameliorated as shown by the reduction of Harvey-Bradshaw index and Crohn disease activity index (CDAI) at 12 and 24 months of treatment (P = .03 and P = .04, respectively) associated with reduction of C-reactive protein at 12 and 24 months (P = .04 for both comparisons) of treatment. SpA assessment revealed a significant reduction in tender joint count at 6 (P = .03), 12 (P = .03), and 24 months (P = .007) of treatment. Swollen joint count, pain, SpA disease activity, and disability reduced in several patients during the follow-up. No adverse events were registered in the follow-up. We demonstrate good clinical efficacy and safety profile of both gastrointestinal and rheumatologic involvement. This may indicate promising therapeutic option for ESpA patients affected by CD, and non-responsive to other TNFi.


Asunto(s)
Anticuerpos Monoclonales/administración & dosificación , Enfermedad de Crohn/tratamiento farmacológico , Espondiloartritis/tratamiento farmacológico , Inhibidores del factor de Necrosis Tumorales/administración & dosificación , Adulto , Anciano , Enfermedad de Crohn/complicaciones , Evaluación de la Discapacidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Espondiloartritis/complicaciones , Resultado del Tratamiento , Adulto Joven
20.
Medicine (Baltimore) ; 100(9): e24926, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33655956

RESUMEN

ABSTRACT: In patients with ischemic stroke, activities of daily living were used as an outcome indicator, and correct assessment is very important. We sought to examine the reliability and validity of the modified Barthel Index as an evaluation tool of activities of daily living in ischemic stroke patients by applying the Rasch analysis.We used a prospectively collected cohort of ischemic stroke patients in the department of neurology. Rasch analysis was used for evaluating the reliability and validity of the modified Barthel Index.A total of 231 patients were included in the analysis. The average of modified Barthel Index was 36.2 ±â€Š17.8. The modified Barthel Index had high reliability of 0.88. There were no extremely mismatched items, and considered unidimensional, but the Point-Measure of bowels and bladder were 0.27, extremely lower than other items. The scale was stable in different sex and age, but had notable differential item functioning in muscle strength of the limbs. Rating categories were not functioning adequately in items. The item difficulty and patient ability were not matched, with a difference of 1.17 logics. 29.4% patients, no easy items could match their ability.The modified Barthel Index had high reliability but a relatively bad matching degree between item difficulty and patient ability. It still needs further improvement to reflect the activities of daily living in ischemic stroke patients.


Asunto(s)
Actividades Cotidianas , Evaluación de la Discapacidad , Psicometría/métodos , Femenino , Humanos , /rehabilitación , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reproducibilidad de los Resultados , Encuestas y Cuestionarios
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