RESUMO
BACKGROUND: The therapeutic efficacy of bone marrow mononuclear cells (BM-MNC) autotransplantation in critical limb ischemia (CLI) has been reported. Variable proportions of circulating monocytes express low levels of CD34 (CD14+CD34lowcells) and behave in vitro as endothelial progenitor cells (EPCs). The aim of the present randomized clinical trial was to compare the safety and therapeutic effects of enriched circulating EPCs (ECEPCs) with BM-MNC administration.MethodsâandâResults:ECEPCs (obtained from non-mobilized peripheral blood by immunomagnetic selection of CD14+and CD34+cells) or BM-MNC were injected into the gastrocnemius of the affected limb in 23 and 17 patients, respectively. After a mean of 25.2±18.6-month follow-up, both groups showed significant and progressive improvement in muscle perfusion (primary endpoint), rest pain, consumption of analgesics, pain-free walking distance, wound healing, quality of life, ankle-brachial index, toe-brachial index, and transcutaneous PO2. In ECEPC-treated patients, there was a positive correlation between injected CD14+CD34lowcell counts and the increase in muscle perfusion. The safety profile was comparable between the ECEPC and BM-MNC treatment arms. In both groups, the number of deaths and major amputations was lower compared with eligible untreated patients and historical reference patients. CONCLUSIONS: This study supports previous trials showing the efficacy of BM-MNC autotransplantation in CLI patients and demonstrates comparable therapeutic efficacy between BM-MNC and EPEPCs.
Assuntos
Transplante de Medula Óssea/métodos , Células Progenitoras Endoteliais/transplante , Isquemia/terapia , Transplante Autólogo/métodos , Idoso , Amputação Cirúrgica , Células da Medula Óssea , Transplante de Medula Óssea/normas , Extremidades/patologia , Feminino , Humanos , Leucócitos Mononucleares/transplante , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida , Transplante Autólogo/normasRESUMO
INTRODUCTION: Borrelia recurrentis, transmitted by Pediculus humanus humanus, is the etiological agent of louse-borne relapsing fever (LBRF). Currently the main focus of endemicity of LBRF is localized in East African countries. From July 2015 to October 2015, 36 cases of LBRF have been diagnosed in Europe in immigrants from the Horn of Africa. Here we report a case of LBRF with meningitis diagnosed in Florence, Italy, in an immigrant arrived from Somalia. CASE STUDY: In October 2015, a 19-year-old Somali male presented to the emergency department of the Azienda Ospedaliero Universitaria Careggi, Florence, Italy, with a 3-day history of high fever. The patient had disembarked in Sicily 10 days before admission after a long migration trip from his country of origin. On clinical examination, neck stiffness was found. Main laboratory findings were thrombocytopenia, increased procalcitonin, and increased polymorphonucleates in the cerebrospinal fluid. Suspecting a possible meningitis, the patient was treated with ceftriaxone, pending results of laboratory testing for malaria, and developed severe hypotension that was treated with fluid resuscitation and hydrocortisone. Hemoscopic testing revealed the presence of spirochetes and no malaria parasites. The patient rapidly improved with doxycycline for 7 days and ceftriaxone for 11 days, then was lost to follow-up. Total DNA from blood was extracted, and amplification and sequencing with universal 16S rDNA primers D88 and E94 revealed a 100% identity with B. recurrentis A1. CONCLUSIONS: LBRF is a rare but emerging infectious disease among vulnerable displaced immigrants from the Horn of Africa. Since immigrants from endemic areas can carry the vector with them, the infection should be suspected even in subjects with compatible clinical features living in the same place where new arrival immigrants are hosted. Healthcare providers should be aware of this condition to implement adequate diagnostic, therapeutic, and public health measures.
Assuntos
Emigrantes e Imigrantes , Meningites Bacterianas/microbiologia , Pediculus/microbiologia , Febre Recorrente/epidemiologia , Animais , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Borrelia/classificação , Borrelia/isolamento & purificação , Ceftriaxona/administração & dosagem , Ceftriaxona/uso terapêutico , Doxiciclina/administração & dosagem , Doxiciclina/uso terapêutico , Humanos , Itália/epidemiologia , Masculino , Febre Recorrente/microbiologia , Somália/epidemiologia , Adulto JovemAssuntos
Aminopiridinas/uso terapêutico , Benzamidas/uso terapêutico , Medicina Baseada em Evidências , Medicina Preventiva , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Agonistas Adrenérgicos beta/uso terapêutico , Albuterol/análogos & derivados , Albuterol/uso terapêutico , Neoplasias da Mama/diagnóstico , Broncodilatadores/uso terapêutico , Ciclopropanos/uso terapêutico , Progressão da Doença , Detecção Precoce de Câncer , Feminino , Humanos , Vacinas contra Papillomavirus , Prevenção Primária , Xinafoato de Salmeterol , Derivados da Escopolamina/uso terapêutico , Prevenção Secundária , Brometo de Tiotrópio , Neoplasias do Colo do Útero/prevenção & controleAssuntos
Cardiologia , Surtos de Doenças , Medicina Baseada em Evidências , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/epidemiologia , Adulto , Cardiologia/economia , Doença Crônica/tratamento farmacológico , Planejamento em Desastres/métodos , Medicina de Família e Comunidade/economia , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Vigilância da População/métodos , Garantia da Qualidade dos Cuidados de Saúde/economia , Reembolso de Incentivo , Índice de Gravidade de Doença , Reino Unido/epidemiologiaAssuntos
Antagonistas de Androgênios/administração & dosagem , Doenças Cardiovasculares , Medicina Baseada em Evidências , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/radioterapia , Antagonistas de Androgênios/uso terapêutico , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Sobrevida , Fatores de TempoAssuntos
Doenças Cardiovasculares , Medicina Baseada em Evidências , Medicina de Família e Comunidade , Medicina Interna , Dieta Mediterrânea , Fibras na Dieta/uso terapêutico , Acessibilidade aos Serviços de Saúde , Humanos , Síndrome do Intestino Irritável/terapia , Mentha piperita , Parassimpatolíticos/uso terapêutico , Óleos de Plantas/uso terapêutico , Saúde Pública , Acidente Vascular Cerebral/terapiaAssuntos
Cardiologia , Medicina Baseada em Evidências , Oncologia , Antineoplásicos/uso terapêutico , Antineoplásicos Alquilantes/uso terapêutico , Antineoplásicos Hormonais/uso terapêutico , Ácidos Borônicos/uso terapêutico , Bortezomib , Neoplasias da Mama/diagnóstico , Diagnóstico por Computador , Quimioterapia Combinada , Feminino , Humanos , Mamografia , Melfalan/uso terapêutico , Mieloma Múltiplo/tratamento farmacológico , Prednisona/uso terapêutico , Pirazinas/uso terapêuticoAssuntos
Tomada de Decisões , Obstrução Intestinal , Doença Aguda , Cuidados Críticos , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/etiologia , Obstrução Intestinal/fisiopatologia , Obstrução Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
The growing number of research on quality of life is stimulated by the need to compare therapeutic treatments that have a similar efficacy to reduce mid- and long-term mortality, but that can warrant different levels of quality of life. The aim of this review was to describe theories and applications of different questionnaires (generic vs specific), methodology to construct a new questionnaire, and the methods of translation and cross-cultural adaptation in another language. Finally, the characteristics of the Coronary Revascularization Outcome Questionnaire, a validated instrument that measures symptoms, physical, psychosocial and cognitive function, adverse effects and satisfaction with treatment for bypass surgery and coronary angioplasty are described. The Italian version is actually used in a multicenter trial in several heart surgery and interventional departments.