Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 28.932
Filtrar
1.
Medicine (Baltimore) ; 99(28): e20946, 2020 Jul 10.
Artículo en Inglés | MEDLINE | ID: mdl-32664094

RESUMEN

BACKGROUND: The beach chair position (BCP), used during shoulder surgery, is associated with hypotension, bradycardia, and risk of cerebral hypoperfusion. Phenylephrine is commonly used as a first treatment of choice of intraoperative hypotension during surgery. We evaluated the hemodynamic effects of 2 doses of intravenous phenylephrine infusion administered before being placed in BCP for arthroscopic shoulder surgery. The primary endpoint was the incidence of hypotension after positional change. METHODS: Sixty-six patients were randomized to receive either intravenous normal saline (group NS) or intravenous phenylephrine infusion (0.5 µg/kg/min, group LP or 1.0 µg/kg/min, group HP) for 5 minutes before being placed in the BCP. Mean arterial pressure(MAP), heart rate, stroke volume variation, and cardiac index were measured before and after positional change. RESULTS: The total incidence of hypotension after the BCP was 93.65%, but was not significantly different among the 3 groups. However, there was a significant difference in trends between the groups for MAP for 5 minutes after BCP (P = .028). Comparison of changes in MAP at 1 minute compared to post-induction MAP was significantly different between group HP and group NS (P = .014). CONCLUSION: Infusion of 0.5 and 1.0 µg/kg/min of phenylephrine for 5 minutes before the BCP has no preventive effect for incidence of hypotension. However, this study showed that 1.0 µg/kg/min of phenylephrine infusion for 5 minutes can attenuate the severity of hypotension.


Asunto(s)
Hipotensión/etiología , Hipotensión/prevención & control , Complicaciones Intraoperatorias/etiología , Complicaciones Intraoperatorias/prevención & control , Posicionamiento del Paciente/efectos adversos , Fenilefrina/administración & dosificación , Anciano , Femenino , Humanos , Hipotensión/epidemiología , Incidencia , Infusiones Intravenosas , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Método Simple Ciego
2.
Medicine (Baltimore) ; 99(28): e21009, 2020 Jul 10.
Artículo en Inglés | MEDLINE | ID: mdl-32664105

RESUMEN

OBJECT: To explore the feasibility and practicability of making virtual three-dimensional model of skull defect and customizing titanium implant by skull three-dimensional CT examination of low dose. METHODS: Sixty patients with skull defects who underwent skull three-dimensional CT before cranioplasty were randomly divided into 4 groups: group A (conventional dose 120 peak Kilovoltage (kVp), 150 tube current time product (mAs)), low dose group B (120 kVp, 50 mAs), low dose group C (100 kVp, 50 mAs), low dose group D (100 kVp, 30 mAs). After the scanning, we compared radiation doses and image quality among the groups. The CT data were sent to the reconstruction company to produce accurate titanium implants, and neurosurgeons performed cranioplasty. After the operation, patients immediately underwent head CT scans to confirm the accuracy of the implantation position, and a series of clinical functions were evaluated. RESULTS: There were significant differences in dose length product (DLP) and effective dose (ED) among the 4 groups (P < .001). The volume CT dose index (CDTIvol), DLP, and ED in group D were, respectively, 87.1%, 86.9%, and 87.3% lower than those in group A (P < .001). All images quality were at or above the general level, and there was no statistical difference (P > .05). Titanium implants were successfully manufactured, every cranioplasty was carried out smoothly, and the clinical function of patients recovered well. CONCLUSION: Customizing titanium implant with three-dimensional CT imaging of low dose in skull not only met the clinical requirements, but also significantly reduced the radiation dose and hazard.


Asunto(s)
Diseño Asistido por Computadora , Imagenología Tridimensional , Diseño de Prótesis/métodos , Cráneo/cirugía , Titanio , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Anciano , Niño , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dosis de Radiación , Método Simple Ciego , Cráneo/efectos de la radiación , Adulto Joven
3.
Medicine (Baltimore) ; 99(28): e21228, 2020 Jul 10.
Artículo en Inglés | MEDLINE | ID: mdl-32664177

RESUMEN

BACKGROUND: Recent years have witnessed wide applications of exergames to balance training among the older adults. However, research concerning balance training with the use of Kinect for Xbox has remained scarce. While previous studies have shown the positive effects of exergames on improving balance and preventing falling among the older adults, there has been a paucity of empirical evidence supporting the superiority of Kinect exercise to conventional exercise over balance training among the older adults. Therefore, this study aimed to compare the feasibility, safety, and effectiveness of Kinect exercise against conventional exercise over balance training among the community older adults. METHOD: A total of 20 participants were randomly assigned to the Kinect Exercise Group (N = 10) or the Conventional Exercise Group (N = 10) for a 5-week balance training (45 minutes a time, 2 times a week). Assessor blinding was employed to assess the participants' performance before and after the treatment, including 30-Second Chair Stand Test (30-sec CST), Timed Up and Go (TUG), Functional Reach Test (FRT), and One-Leg Stance Test (OLST) respectively with eyes open and closed. Subjective feeling of the intensity of pain and side effects were recorded throughout the investigation period. Nonparametric statistics was used for data analysis. RESULTS: Within-group comparison between the pre-test and post-test indicated that significant differences existed in all of the 5 tests (30-sec CST, TUG, FRT, OLST with eyes open, and OLST with eyes closed) in the Kinect exercise group. To the Conventional exercise group, however, significant differences were only observed in 30-sec CST, FRT and OLST with eyes open. With regard to between-group comparison, significant differences were only found in FRT. CONCLUSION: Such results indicated that both treatments were helpful in improving the participants' balance performance, that Kinect exercise was more effective in terms of overall balance ability, and that Kinect exercise was particularly beneficial to functional reach enhancement in comparison with traditional exercise. Kinect exercise could be a feasible, safe, and effective alternative for dynamic balance training among older adults.


Asunto(s)
Accidentes por Caídas/prevención & control , Terapia por Ejercicio/métodos , Equilibrio Postural/fisiología , Juegos de Video , Anciano , Estudios de Factibilidad , Femenino , Humanos , Vida Independiente , Masculino , Persona de Mediana Edad , Método Simple Ciego , Resultado del Tratamiento
4.
Medicine (Baltimore) ; 99(27): e20967, 2020 Jul 02.
Artículo en Inglés | MEDLINE | ID: mdl-32629706

RESUMEN

BACKGROUND: Hypertension is a silent disease of the masses with an increasing prevalence and poor control rates. This study aims to establish and test the efficacy of a nurse-led hypertension management model in the community. METHODS: A single-blind, randomized controlled trial was performed. 156 hypertensive patients with uncontrolled blood pressure were equally and randomly allocated into 2 groups. Patients in the study group received a 12-week period of hypertension management. Blood pressure, self-care behaviors, self-efficacy, and satisfaction were assessed at the start of recruitment, 12 and 16 weeks thereafter. RESULTS: After the intervention, blood pressure of patients in the study group had greater improvement in self-care behaviors and a higher level of satisfaction with the hypertensive care compared to the control group (both P < .05). CONCLUSIONS: The nurse-led hypertension management model is feasible and effective for patients with uncontrolled blood pressure in the community.


Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Hipertensión/enfermería , Pautas de la Práctica en Enfermería/normas , Anciano , Antihipertensivos/uso terapéutico , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Autocuidado , Autoeficacia , Método Simple Ciego
5.
Drug Discov Ther ; 14(3): 129-134, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32669521

RESUMEN

The aim of this randomized, single-blind, active-controlled pilot study was to investigate the clinical efficacy of oral supplementation with Verbascox®, a proprietary herbal extract capable of inhibiting human cyclooxygenase-2 (COX-2), in patients with mild-to-moderate osteoarthritis (OA) of the knee. Patients in the control group (n = 50) did not undergo any treatment (watchful waiting). Patients in the Verbascox® group (n = 50) received oral supplementation (800 mg/day) with the herbal extract for 2 weeks. The final study group consisted of patients (n = 50) who received celecoxib, a known pharmacological inhibitor of COX-2, 200 mg/day for 2 weeks. Examining physicians and laboratory personnel were blinded to group assignment, whereas patients were unblinded. All participants were evaluated using standard measures of pain relief and improvement in functional capacity at baseline, after 1 week, and at the end of the 2-week treatment course. Moreover, serum levels of substance P (SP), a member of the tachykinin family of neuropeptides involved in pain perception, were measured at the three time points. Both Verbascox® and celecoxib reduced pain, improved functional capacity, and lowered serum SP levels at 2 weeks compared with baseline, without significant inter-arm differences. Both Verbascox® and celecoxib showed a limited number of treatment-emergent adverse events. In summary, oral supplementation with Verbascox® (800 mg/day) in patients with mild-to-moderate OA of the knee is as effective and safe as a standard therapeutic dose of celecoxib in terms of pain relief and improvement in functional capacity after a 2-week treatment course.


Asunto(s)
Celecoxib/uso terapéutico , Inhibidores de la Ciclooxigenasa 2/uso terapéutico , Osteoartritis de la Rodilla/tratamiento farmacológico , Dimensión del Dolor/efectos de los fármacos , Dimensión del Dolor/métodos , Preparaciones de Plantas/uso terapéutico , Adulto , Anciano , Celecoxib/farmacología , Inhibidores de la Ciclooxigenasa 2/farmacología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Preparaciones de Plantas/farmacología , Método Simple Ciego , Resultado del Tratamiento
6.
Anticancer Res ; 40(7): 4115-4121, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32620660

RESUMEN

BACKGROUND/AIM: Magnetic resonance (MR) and ultrasound (US) fusion imaging (MR-US fusion) is already used to guide prostate biopsies and has been proven accurate for diagnosing cervical cancer. In this study, we aimed to evaluate the feasibility and performance of MR-US fusion for characterizing adnexal masses. PATIENTS AND METHODS: A retrospective study was conducted between 2014 and 2018 including women referred to our Gynaecological Oncology Department for characterization of an adnexal mass (n=106). Performance of MR-US fusion was evaluated in a subgroup of patients who underwent surgery (n=26). Two readers, blinded to final histology, performed and rated US findings according to the International Ovarian Tumor Analysis simple rules score, MR according to Ovarian-Adnexal Reporting Data System Magnetic score, and MR-US fusion through a tailored score. The reference outcome was the final pathology. RESULTS: MR-US fusion had a sensitivity of 100% (95%CI=80-100), specificity of 89% (95%CI=52-99), positive likelihood ratio of 9 (95%CI=1.4-57), and accuracy of 96% (95%CI=80-99). CONCLUSION: MR-US fusion is feasible for characterizing adnexal masses to predict ovarian cancer.


Asunto(s)
Imagen por Resonancia Magnética , Neoplasias Ováricas/diagnóstico por imagen , Ovario/diagnóstico por imagen , Ultrasonografía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Factibilidad , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/patología , Ovario/patología , Método Simple Ciego , Adulto Joven
7.
Trials ; 21(1): 614, 2020 Jul 06.
Artículo en Inglés | MEDLINE | ID: mdl-32631405

RESUMEN

OBJECTIVES: This study will evaluate the main hypothesis that supplementation with vitamins A, B, C, D, and E significantly improves the severity and mortality rate in ICU patients with COVID-19. TRIAL DESIGN: This study is a randomized, single-blinded, two-arm (1:1 ratio) parallel group clinical trial. PARTICIPANTS: We are conducting this study in patients with COVID-19 admitted to intensive care units at the Imam Khomeini Hospital Complex in Tehran, Iran. The inclusion criteria are as follows: (1) aged between 20 and 60 years, (2) both male and female patients with COVID-19, (3) clinical or definitive diagnosis (using polymerase chain reaction (PCR) test), (4) patients have not participated in other clinical trials, and (5) no renal or hepatic abnormalities. The exclusion criteria are as follows: (1) patients with specific and rare viral diseases such as HIV and (2) patients who have been undergoing chemotherapy for the past month. INTERVENTION AND COMPARATOR: Duration of intervention: 7 days from randomization Intervention in the treatment group: Vitamin A 25,000 IU daily Vitamin D 600,000 IU once during study Vitamin E 300 IU twice daily Vitamin C is taken four times per day B vitamins are taken as a daily Soluvit [which included thiamine nitrate 3.1 mg, sodium riboflavin phosphate 4.9 mg (corresponding to vitamin B2 3.6 mg), nicotinamide 40 mg, pyridoxine hydrochloride 4.9 mg (corresponding to vitamin B6 4.0 mg), sodium pantothenate 16.5 mg (corresponding to pantothenic acid 15 mg), sodium ascorbate 113 mg (corresponding to vitamin C 100 mg), biotin 60 µg, folic acid 400 µg, and cyanocobalamin 5 µg] The control group will not receive any supplements or placebo. All supplements are made in Iran except for Soluvit (from Fresenius Kabi, New Zealand). MAIN OUTCOMES: 1. Weight, height, and BMI 2. Severity of pulmonary involvement according to CT scan 3. Respiratory support (invasive or non-invasive) 4. Percentage of oxygen saturation (SpO2 level) 5. Serum levels of WBC, CRP, ESR, IL6, IFN-G, and TNF-α 6. The patient's body temperature 7. The presence or absence of involvement of organs other than the lungs (e.g., heart, liver, kidneys) 8. Duration of hospitalization 9. Mortality rate RANDOMIZATION: At baseline, eligible patients were randomly assigned to a 1:1 ratio to one of two groups: intervention and control. Block randomization is used based on the gender of patients. BLINDING (MASKING): Patients are unaware of being placed in the intervention or control groups after signing consent. All treatment staff will be aware of which group each of the patients is in due to the specific conditions of the ICU and the absence of placebo for the control group. NUMBERS TO BE RANDOMIZED (SAMPLE SIZE): The researchers plan to include 60 patients in total, with 30 patients in each group. TRIAL STATUS: This is the first version of the protocol which started on April 2, 2020. Recruitment began April 2, 2020, and is expected to be complete by July 4, 2020. TRIAL REGISTRATION: The Iranian Registry of Clinical Trials IRCT20200319046819N1 . Registered on April 4, 2020 FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this letter serves as a summary of the key elements of the full protocol (Fig. 1, Table 1).


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/terapia , Suplementos Dietéticos , Neumonía Viral/terapia , Ensayos Clínicos Controlados Aleatorios como Asunto , Vitaminas/administración & dosificación , Adulto , Ácido Ascórbico/administración & dosificación , Infecciones por Coronavirus/mortalidad , Femenino , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/mortalidad , Método Simple Ciego , Vitamina A/administración & dosificación , Complejo Vitamínico B/administración & dosificación , Vitamina D/administración & dosificación
8.
Stomatologiia (Mosk) ; 99(3): 22-26, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-32608944

RESUMEN

THE AIM: To study the effect of toothbrushes of various types on the accumulation of plaque and the proteolytic potential of gingival fluid as a pathogenic factors in long-term orthodontic treatment of patients with a distal permanent bite. MATERIAL AND METHODS: We examined 63 patients of both sexes aged 11-18 years. Orthodontic treatment was carried out for the close position of the teeth with a distal permanent bite (K07.2) and cleft palate and lips (Q37.1). Patients were divided into three groups depending on the type of toothbrush used for individual oral hygiene: group 1 (n=21) - an orthodontic manual toothbrush (Professor Persin, «Spazzolificio Piave¼, Italy); Group 2 (n=22) - an ultrasonic toothbrush (Emmi-dent, EMAG AG, Germany) and group 3 (n=20) - an electric toothbrush ("Oral-B Pro-Expert, «Procter & Gamble¼, USA). RESULTS: The amount of soft plaque was assessed by the Silness-Loe hygiene index in the subgingival region. The activity of proteolytic enzymes - elastase, collagenase, and a α-inhibitor of proteinases was determined by the enzymatic method using a XL 200 biochemical analyzer («Erba Lachema¼, Czech Republic). The accumulation of plaque in the gingival region on both jaws during the entire period of orthodontic treatment is most pronounced when using a manual brush compared to ultrasonic and electric brushes. An increase in proteolytic activity in the gingival fluid with a simultaneous decrease in antiprotease potential with long-term orthodontic treatment of patients was observed when using a manual orthodontic brush, which can be regarded as an increase in the activity of the pathogenic factors for the development of local inflammatory and destructive changes. CONCLUSION: To prevent inflammatory and destructive changes during prolonged orthodontic treatment of patients, the use of ultrasonic and electric toothbrushes in daily oral hygiene is justified.


Asunto(s)
Gingivitis , Aparatos Ortodóncicos , Adolescente , Niño , Índice de Placa Dental , Femenino , Humanos , Masculino , Índice Periodontal , Método Simple Ciego , Cepillado Dental
9.
J Indian Soc Pedod Prev Dent ; 38(2): 177-183, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32611865

RESUMEN

Background: Topical anesthetics have an intrinsic part to reduce pricking pain sensation due to needle stick before injection in children. Aim: The present study aimed to determine the effectiveness of a novel herbal anesthetic gel used as a topical anesthetic before an inferior alveolar nerve block. SettingsandDesign: This was a bilateral split-mouth, single blind, crossoverin vivo study. Methods: Atotal number of 30 children were selected for this study design. After the application of the topical anesthesia, a 26-gauge needle was inserted in the mucobuccal fold and local anesthetic solution was deposited. Assessment of pain perception was done before the procedure and at the time of needle penetration using hemodynamic parameters such as blood pressure and heart rate. The objective and subjective pain assessment was recoded through sound eye motor scale and Faces Pain Scale-Revised (FPS-R). StatisticalAnalysis: As the data followed a normal distribution, parametric tests were used to analyze these data. The independent sample t-test and paired sample t-test were used to check the mean differences. Results: The data showed no statistically significant differences in the objective and subjective pain assessment values of the novel herbal anesthetic gel compared to the 2% lignocaine gel. However, the intragroup comparisons of the before and during treatment results showed statistically significant results (P < 0.05). Conclusion: The novel herbal anesthetic gel was effective and safe in reducing the pain from needle insertion. Thus, setting up scientific evidence for the therapeutic usage of herbal products can, therefore, assist to develop a more efficient and alternative topical anesthetic.


Asunto(s)
Anestesia Dental , Lidocaína , Anestésicos Locales , Niño , Humanos , Boca , Método Simple Ciego
10.
Trials ; 21(1): 504, 2020 Jun 08.
Artículo en Inglés | MEDLINE | ID: mdl-32513231

RESUMEN

OBJECTIVES: To determine the efficacy of Hydroxychloroquine vs. Hydroxychloroquine + Nitazoxanide in reducing the need for invasive mechanical ventilatory support for patients with COVID-19. Hydroxychloroquine is currently being used in multiple trials with varying doses in an attempt to treat COVID-19. Nitazoxanide has powerful antiviral effects and proven efficacy against a range of viruses including SARS and MERS. Dual therapy by combining appropriate doses of these two medications with diverse activities against COVID-19 is expected to be better than monotherapy with hydroxychloroquine. TRIAL DESIGN: This is a single centre, randomized, controlled, single blinded, 2 arm (ratio 1:1) parallel group trial. PARTICIPANTS: 86 COVID-19 positive patients that are being treated at the Health Institute of the State of Mexico (ISEM) in Toluca, State of Mexico will be recruited from May 14 to December 31, 2020. INCLUSION CRITERIA: 1)Age older than 18 years.2)Hospitalised COVID-19 PCR test positive patients.3)Within the first 72 hours after performing the PCR test.4)Presence of risk factors for complications (at least one): over 60 years, history of diabetes mellitus, hypertension, and morbid obesity. EXCLUSION CRITERIA: 1)Patients with corrected QT interval (QTc) greater than 500ms at hospital admission.2)Patients who have inherent contraindications to each drug.3)Patients who are unable to consent.4)Patients who have previously received chloroquine.5)Patients already intubated. Elimination criteria: 1)Patients whose clinical follow-up is lost or who decide not to continue in the study INTERVENTION AND COMPARATOR: The two management alternatives will be: Control - Hydroxychloroquine 200 mg taken orally every 12 hours for 7 days. Dual therapy - Hydroxychloroquine 400 mg taken orally every 12 hours for two days and then 200 mg taken orally every 12 hours for four days + Nitazoxanide 500 mg orally every 6 hours taken with food, for seven days. MAIN OUTCOMES: Primary: Mechanical ventilation requirement assessed at one week. Percentage of COVID-19 positive patients who require mechanical ventilation . All patients will be monitored till hospital discharge or death. RANDOMISATION: Patients will be randomly allocated using allocation papers and opaque sealed envelopes to either receive the placebo or the dual therapy intervention treatment in a 1:1 ratio until we have recruited the required number of patients for each group. BLINDING (MASKING): Trial participants will be blinded. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): 86 participants will be randomized to each group, with 43 in the control group and 43 in the dual therapy group. TRIAL STATUS: Protocol version: 2, recruitment will begin on May 14 until sample size is reached , with the analysis deadline of December 31st 2020. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04341493. Date of trial registration: April 10, 2020 FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest of expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/tratamiento farmacológico , Hidroxicloroquina/uso terapéutico , Neumonía Viral/tratamiento farmacológico , Ensayos Clínicos Controlados Aleatorios como Asunto , Tiazoles/administración & dosificación , Infecciones por Coronavirus/complicaciones , Quimioterapia Combinada , Humanos , Hidroxicloroquina/administración & dosificación , Pandemias , Neumonía Viral/complicaciones , Pronóstico , Respiración Artificial , Factores de Riesgo , Método Simple Ciego
11.
Am Heart J ; 225: 38-43, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32485328

RESUMEN

BACKGROUND: Previous studies have implied the efficacy and safety of argatroban plus recombinant tissue-type plasminogen activator (r-tPA) in patients with acute ischemic stroke. Further trials are needed to establish convincing conclusions in a large sample size. RESEARCH DESIGN AND METHODS: Argatroban plus r-tPA for Acute Ischemic Stroke (ARAIS) trial is a multicenter, prospective, randomized, open-label, and blind-end point trial. The trial proposes to randomize 808 patients with acute ischemic stroke National Institutes of Health Stroke Scale (NIHSS score≥ 6 at the time of randomization) within 4.5 hours of symptom onset to receive argatroban (100 µg/kg bolus followed by an infusion of 1.0 µg/kg per minute for 48 hours) plus r-tPA or r-tPA alone. The primary end point is the proportion of patients with an excellent outcome of no clinically significant residual stroke deficits (modified Rankin scale 0-1) at 90 days. Secondary end points include the proportion of patients with a good outcome (modified Rankin scale 0-2) at 90 days, early neurological improvement (NIHSS score ≥2-point decrease) at 48 hours, early neurological deterioration (NIHSS score ≥4-point increase) at 48 hours, decrease in the NIHSS score from baseline to 14 days, and stroke recurrence or other vascular events at 90 days. Safety end points include symptomatic intracerebral hemorrhage, parenchymal hematoma type 2, and major systemic bleeding. CONCLUSION: ARAIS trial will evaluate whether argatroban plus r-tPA is superior to r-tPA alone in improving functional outcomes in acute ischemic stroke patients in a large sample population.


Asunto(s)
Antitrombinas/uso terapéutico , Ácidos Pipecólicos/uso terapéutico , Accidente Cerebrovascular/tratamiento farmacológico , Activador de Tejido Plasminógeno/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Quimioterapia Combinada , Femenino , Humanos , Análisis de Intención de Tratar , Masculino , Persona de Mediana Edad , Método Simple Ciego , Adulto Joven
12.
Bone Joint J ; 102-B(6_Supple_A): 73-78, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32475277

RESUMEN

AIMS: The purpose of this study was to use pharmacogenetics to determine the frequency of genetic variants in our total knee arthroplasty (TKA) patients that could affect postoperative pain medications. Pharmacogenetic testing evaluates patient DNA to determine if a drug is expected to have a normal clinical effect, heightened effect, or no effect at all on the patient. It also predicts whether patients are likely to experience side effects from medicine. We further sought to determine if changing the multimodal programme based on these results would improve pain control or reduce side effects. METHODS: In this pilot study, buccal samples were collected from 31 primary TKA patients. Pharmacogenetics testing examined genetic variants in genes OPRM1, CYP1A2, CYP2B6, CYP2C19, CYP3A4, CYP2C9, and CYP2D6. These genes affect the pharmacodynamics and pharmacokinetics of non-steroidal anti-inflammatory drugs and opioids. We examined the frequency of genetic variants to any of the medications we prescribed including celecoxib, hydrocodone, and tramadol. Patients were randomized to one of two groups: the control group received the standard postoperative pain regimen, and the study group received a customized regimen based on the pharmacogenetic results. For the first ten postoperative days, patients recorded pain scores, medication, and side effects. RESULTS: Genetic variants involving one or more medications in the multimodal pain protocol occurred in 13 of the 31 patients (42%). In total, eight patients (26%) had variants affecting more than one of the medications. For the 25 patients who recorded pain and medication logs, the mean pain levels and morphine equivalents (MEQs) consumed in the first ten days were higher in the control group than in the custom-guided group (p = 0.019 for pain and p = 0.655 for MEQ). CONCLUSION: Overall, 42% of patients had a variant involving one of the pain medications prescribed in our perioperative pain program for TKA. Ongoing research will help determine if using these data to modify a patient's medication will improve outcomes. Cite this article: Bone Joint J 2020;102-B(6 Supple A):73-78.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Artroplastia de Reemplazo de Rodilla , Manejo del Dolor/métodos , Dolor Postoperatorio/tratamiento farmacológico , Dolor Postoperatorio/genética , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas de Farmacogenómica , Proyectos Piloto , Estudios Prospectivos , Método Simple Ciego
13.
Eur J Paediatr Dent ; 21(2): 110-114, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32567941

RESUMEN

AIM: To investigate whether the daily use of a spray containing an aqueous extract of Triticum vulgare (TV), belonging to the family of Graminaceae, associated with supervised toothbrushing may improve gingival health in schoolchildren with mixed dentition. MATERIALS AND METHODS: Study design: Randomised, controlled, single-centre, examiner blind, parallel-group study. The study population included 57 schoolchildren with plaque-induced gingivitis randomly allocated to test (n = 29) and control (n = 28) group. Both groups were enrolled in a mechanical plaque control programme for a period of 2 weeks. The test group was also instructed to use a gluten free spray formulation of TV spray twice daily after toothbrushing. Evaluations of plaque index, modified gingivitis index (GI), salivary pH and whole stimulated saliva quantity took place at baseline and after 1 and 2 weeks of study product use. RESULTS: No side effects were observed. Plaque accumulation and GI statistically significantly improved compared with baseline in both groups (all P-values < 0.005), while salivary pH remained nearly unchanged. Between-group differences in index reduction were statistically significant only for GI favouring the test group (P = 0.013). STATISTICS: Repeated-measures ANOVA and the Friedman test were applied to evaluate the influence of time on quantitative variables within each treatment group. Differences between test and control groups were tested using the unpaired t test or the Mann-Whitney U-test with Bonferroni correction. CONCLUSIONS: This study found that TV in spray formulation is safe and effective in controlling gingival inflammation. Thus, it may be a potential adjuvant in the treatment of gingivitis in combination with mechanical plaque control in schoolchildren.


Asunto(s)
Placa Dental , Gingivitis , Niño , Índice de Placa Dental , Humanos , Inflamación , Vaporizadores Orales , Método Simple Ciego , Cepillado Dental , Triticum
14.
South Med J ; 113(6): 261-266, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32483634

RESUMEN

OBJECTIVES: Hepatitis C virus (HCV) is highly curable with antiviral therapy, and traditionally, treatment adherence has been critical for treatment success. We sought to determine whether assessing HCV treatment readiness with a structured treatment readiness tool was associated with increased rates of adherence and cure among patients at a safety-net HCV clinic. METHODS: We administered the Psychosocial Readiness Evaluation and Preparation for HCV Treatment (PREP-C) tool to 50 patients and compared them with 50 patients who received the usual care. The outcome measures included achievement of treatment milestones (eg, adherence to treatment, clinic visit attendance) and sustained virologic response (cure). RESULTS: We found no association between receiving the PREP-C assessment and outcomes, including referral to or starting HCV treatment, adherence to treatment, and HCV cure. CONCLUSIONS: We found that receiving the PREP-C assessment did not improve treatment outcomes, suggesting that targeted pretreatment assessment is unnecessary even in a medically and psychosocially complex population.


Asunto(s)
Antivirales/uso terapéutico , Cognición , Hepatitis C Crónica/tratamiento farmacológico , Cumplimiento de la Medicación , Motivación , Apoyo Social , Respuesta Virológica Sostenida , Anciano , Consumo de Bebidas Alcohólicas/epidemiología , Citas y Horarios , Hepatitis C Crónica/psicología , Humanos , Masculino , Trastornos Mentales/epidemiología , Salud Mental , Persona de Mediana Edad , Pacientes no Presentados , Proveedores de Redes de Seguridad , Autoeficacia , Método Simple Ciego , Trastornos Relacionados con Sustancias/epidemiología , Encuestas y Cuestionarios , Resultado del Tratamiento
15.
N Engl J Med ; 382(24): 2316-2326, 2020 06 11.
Artículo en Inglés | MEDLINE | ID: mdl-32521133

RESUMEN

BACKGROUND: Randomized trials involving patients with stroke have established that outcomes are improved with the use of thrombectomy for large-vessel occlusion. These trials were performed in high-resource countries and have had limited effects on medical practice in low- and middle-income countries. METHODS: We studied the safety and efficacy of thrombectomy in the public health system of Brazil. In 12 public hospitals, patients with a proximal intracranial occlusion in the anterior circulation that could be treated within 8 hours after the onset of stroke symptoms were randomly assigned in a 1:1 ratio to receive standard care plus mechanical thrombectomy (thrombectomy group) or standard care alone (control group). The primary outcome was the score on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) at 90 days. RESULTS: A total of 300 patients were enrolled, including 79 who had undergone thrombectomy during an open-label roll-in period. Approximately 70% in the two groups received intravenous alteplase. The trial was stopped early because of efficacy when 221 of a planned 690 patients had undergone randomization (111 to the thrombectomy group and 110 to the control group). The common odds ratio for a better distribution of scores on the modified Rankin scale at 90 days was 2.28 (95% confidence interval [CI], 1.41 to 3.69; P = 0.001), favoring thrombectomy. The percentage of patients with a score on the modified Rankin scale of 0 to 2, signifying an absence of or minor neurologic deficit, was 35.1% in the thrombectomy group and 20.0% in the control group (difference, 15.1 percentage points; 95% CI, 2.6 to 27.6). Asymptomatic intracranial hemorrhage occurred in 51.4% of the patients in the thrombectomy group and 24.5% of those in the control group; symptomatic intracranial hemorrhage occurred in 4.5% of the patients in each group. CONCLUSIONS: In this randomized trial conducted in the public health care system of Brazil, endovascular treatment within 8 hours after the onset of stroke symptoms in conjunction with standard care resulted in better functional outcomes at 90 days than standard care alone. (Funded by the Brazilian Ministry of Health; RESILIENT ClinicalTrials.gov number, NCT02216643.).


Asunto(s)
Accidente Cerebrovascular/cirugía , Trombectomía , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Terapia Combinada , Procedimientos Endovasculares , Femenino , Fibrinolíticos/uso terapéutico , Humanos , Hemorragias Intracraneales/etiología , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Método Simple Ciego , Accidente Cerebrovascular/tratamiento farmacológico , Accidente Cerebrovascular/mortalidad , Trombectomía/efectos adversos , Trombectomía/métodos , Tiempo de Tratamiento , Activador de Tejido Plasminógeno/uso terapéutico , Resultado del Tratamiento , Adulto Joven
16.
Medicine (Baltimore) ; 99(23): e20625, 2020 Jun 05.
Artículo en Inglés | MEDLINE | ID: mdl-32502040

RESUMEN

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a common high-burden and highly disabling lung disease. The quality of life and exercise endurance of patients with COPD is often low because of atrophy of the respiratory and skeletal muscles. Although recommended by the global initiative for chronic obstructive lung disease guidelines, pulmonary rehabilitation (PR) has not been used widely because of its inherent limitations. Tuna-Hui-Chun-Gong (TNHCG) is a popular traditional exercise used to treat COPD in China. We aim to evaluate the safety and efficacy of TNHCG for PR of COPD. METHODS: The provided protocol is for a single-blind randomized controlled trial in which 120 COPD patients will be randomly and equally divided into the experimental or control group. The control group will be treated with standard COPD drugs while the experimental group will perform TNHCG exercises apart from standard drug treatment. The duration of treatment will be 24 weeks and a follow-up for 48 weeks. The primary outcome will be the 6-Minute Walk Test. The secondary outcomes will include the pulmonary function test, St George's respiratory questionnaire, COPD assessment test, modified medical research council dyspnea scale, Hospital Anxiety and Depression Scale, and exacerbation frequency. A safety assessment will also be performed during the trial. DISCUSSION: Our study will provide evidence to support TNHCG exercise as an additional measure for PR of COPD. TRIAL REGISTRATION: ChiCTR1900028332, Registered December 29, 2019. ETHICS AND DISSEMINATION: Ethics approval has been granted by the Sichuan Traditional Chinese Medicine Regional Ethics Review Committee (No. 2019KL-050).


Asunto(s)
Tolerancia al Ejercicio , Ejercicio Físico , Medicina China Tradicional/métodos , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Calidad de Vida , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Método Simple Ciego , Resultado del Tratamiento , Prueba de Paso
17.
Medicine (Baltimore) ; 99(22): e20317, 2020 May 29.
Artículo en Inglés | MEDLINE | ID: mdl-32481404

RESUMEN

BACKGROUND: Patients with esophageal cancer suffer from anxiety in the perioperative period surrounding esophagectomy; this may increase the risk of postoperative complications. In particular, postoperative aspiration pneumonia carries a high risk of hospital mortality. Bukuryoingohangekobokuto (BRIHK) is a traditional Japanese medicine formula used to treat anxiety, the feeling of a foreign body in the esophagus, and water brash. We hypothesize that BRIHK might be effective for both anxiety and water brash in perioperative patients with esophageal cancer. The aim of this study is to evaluate the efficacy and safety of BRIHK compared to a placebo for anxiety and water brash in perioperative esophageal cancer patients. METHOD/DESIGN: This will be a single-center, single blind, placebo-controlled randomized clinical trial. Twenty-four patients with esophageal cancer undergoing radical resection surgery will be registered to participate, then randomly and blindly assigned to the BRIHK treatment group or control group. Patients will be administered BRIHK or the placebo from 2 weeks before to 6 weeks after surgery. Primary outcome measures will be anxiety and depression (assessed using the Hospital Anxiety and Depression Scale), and water brash (assessed using the 10-item Eating Assessment Tool, Esophagus and Stomach Surgery Symptom Scale, and videofluoroscopy swallowing measurement). Incidences of aspiration pneumonia will be noted and abdominal gas volume, inflammatory markers, and nutrition status will be evaluated. DISCUSSION: This investigative study will provide clinical evidence of BRIHK administration for anxiety and water brash, which might improve mental distress and reduce postoperative mortality. TRIAL REGISTRATION: The protocol and progress are registered on the Japan Registry of Clinical Trials (jRCT s021190001) and University Hospital Medical Information Network (UMIN000031330). The protocol was approved by the Japanese Ministry of Health, Labour and Welfare certified clinical research review board, Tohoku University (CRB2180001).


Asunto(s)
Ansiedad/tratamiento farmacológico , Medicamentos Herbarios Chinos/uso terapéutico , Neoplasias Esofágicas/cirugía , Esofagectomía/métodos , Complicaciones Posoperatorias/tratamiento farmacológico , Medicamentos Herbarios Chinos/administración & dosificación , Medicamentos Herbarios Chinos/efectos adversos , Neoplasias Esofágicas/psicología , Humanos , Tiempo de Internación , Método Simple Ciego
18.
Am Heart J ; 225: 44-54, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32474204

RESUMEN

BACKGROUND: Venous thromboembolism (VTE) is a life-threatening disease that can affect each hospitalized patient. But the current in-hospital thromboprophylaxis remains suboptimal and there exists a large gap between clinical practice and guideline-recommended care in China. METHODS: To facilitate implementation of guideline recommendations, we conduct a multicenter, adjudicator-blinded, cluster-randomized clinical trial, aiming to assess the effectiveness of a system-wide multifaceted quality improvement (QI) strategy on VTE prophylaxis improvement and thromboembolism reduction in clinical setting. Hospitals are randomized into intervention or control group. In intervention group, hospitals receive the concept of appropriate in-hospital thromboprophylaxis plus a multifaceted QI which encompasses four components: (1) an electronic alert combining computer-based clinical decision support system and electronic reminders, (2) appropriate prophylaxis based on dynamic VTE and bleeding risk assessments, (3) periodical audit and interactive feedback on performance, (4) strengthened training and patient education. In control, hospitals receive the concept of recommended prophylaxis alone without QI. Thromboprophylaxis will be at the discretion of hospitals and conducted as usual. With a final sample size of 5760 hospitalized patients in 32 hospitals on mainland China, this trial will examine the effect of QI on improvement in thromboprophylaxis and patient-centered outcomes. This is an open-label trial that patients and healthcare professionals will know group allocation after enrollment, but endpoint adjudicators and statisticians will be blinded. RCT# NCT04211181 CONCLUSIONS: The system-wide multifaceted QI intervention is expected to facilitate implementation of recommended VTE prophylaxis in hospital, thereafter reducing VTE incidence and relevant adverse events among hospitalized patients in China.


Asunto(s)
Anticoagulantes/uso terapéutico , Adhesión a Directriz , Hospitales , Mejoramiento de la Calidad , Tromboembolia Venosa/prevención & control , Adulto , Anticoagulantes/efectos adversos , China , Sistemas de Apoyo a Decisiones Clínicas , Hemorragia/inducido químicamente , Humanos , Análisis de Intención de Tratar , Educación del Paciente como Asunto , Guías de Práctica Clínica como Asunto , Modelos de Riesgos Proporcionales , Medición de Riesgo , Método Simple Ciego
19.
Medicine (Baltimore) ; 99(24): e20666, 2020 Jun 12.
Artículo en Inglés | MEDLINE | ID: mdl-32541510

RESUMEN

BACKGROUND: Knee osteoarthritis (KOA) is a common chronic disorder of knee and the leading cause of pain in the elderly with an overall prevalence of 50% in people over 60 years of age. This disease is an important factor affecting the quality of life of middle-aged and elderly people, and its main symptom is knee joint pain. Due to the pain, the knee joint activity function is limited, bringing great pain to patients, affecting their quality of life, effective prevention, and treatment of KOA is a modern medical problem. METHODS: The 60 patients who met the inclusion criteria were randomly divided into the treatment group and the control group. In this study, single center, randomized control and equivalent clinical trial were used for treatment. The treatment group received Yuanhu Zhitong dropping pills within 4 weeks, and the control group received diclofenac sodium sustained-release capsule treatment within 4 weeks. The main measures were visual analogue scale (VAS), WOMAC osteoarthritis index score and gastrointestinal symptoms rating scale (GSRS).Secondary measures included biochemical markers and adverse reactions during treatment. RESULT: The results of this trial will be published on the website of China Clinical Trial Registration Center (http://www.chictr.org.cn/searchprojen.aspx) and in peer-reviewed journals or academic conferences. CONCLUSIONS: This study is to assess the efficacy and safety of Yuanhu Zhitong dropping pills for knee osteoarthritis (KOA). REGISTRATION: PROSPERO (registration number ChiCTR1900024712).


Asunto(s)
Artralgia/tratamiento farmacológico , Artralgia/etiología , Medicamentos Herbarios Chinos/uso terapéutico , Osteoartritis de la Rodilla/complicaciones , Manejo del Dolor/métodos , Fitoterapia , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Proyectos de Investigación , Formas de Dosificación , Humanos , Método Simple Ciego
20.
Medicine (Baltimore) ; 99(24): e20752, 2020 Jun 12.
Artículo en Inglés | MEDLINE | ID: mdl-32541528

RESUMEN

INTRODUCTION: Repetitive peripheral magnetic stimulation (rPMS) therapy is an innovative and minimally invasive neurorehabilitative technique and has been shown to facilitate neural plasticity. However, there is at present no research that clarifies the dose-response of rPMS therapy on the recovery of upper limb hemiparesis after stroke. This trial aims to clarify the dose-response of rPMS therapy combined with intensive occupational therapy (OT) for chronic stroke patients with moderate to severe upper limb hemiparesis. METHODS AND ANALYSIS: This multicenter, prospective, assessor-blinded, randomized controlled study with 3 parallel groups will be conducted from January 20, 2020 to September 30, 2022. Fifty patients will be randomly assigned in a ratio of 1:2:2 to the control group, the group receiving daily 2400 pulses of rPMS, or the group receiving daily 4800 pulses of rPMS, respectively. From the day after admission (Day 1), rPMS therapy and intensive OT will be initiated. The primary outcome is the change in the motor function of the affected upper extremity (Fugl-Meyer Assessment) between the time of admission (Day 0) and the day after 2 weeks of treatment (Day 14). Secondary outcomes will include the changes in spasticity, active range of motion, motor evoked potential, and activity of daily living. ETHICS AND DISSEMINATION: The study was approved by the Jikei University Certified Review Board for all institutions (reference number: JKI19-020). Results of the primary and secondary outcomes will be published in a peer-reviewed journal and presented at international congresses. The results will also be disseminated to patients. TRIAL REGISTRATION NUMBER: jRCTs032190191.


Asunto(s)
Terapia de Campo Magnético/métodos , Terapia Ocupacional , Paresia/rehabilitación , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Rehabilitación de Accidente Cerebrovascular/métodos , Extremidad Superior , Terapia Combinada , Humanos , Estudios Multicéntricos como Asunto , Paresia/etiología , Estudios Prospectivos , Método Simple Ciego , Accidente Cerebrovascular/complicaciones
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA