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Rev. Finlay ; 10(3): 320-324, jul.-set. 2020. graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1143822


RESUMEN El liposarcoma es un tumor maligno de origen mesodérmico derivado del tejido adiposo. Es el más frecuente de los sarcomas de partes blandas en el adulto. La localización más frecuente es en extremidades inferiores; la abdominal es rara. Llega a alcanzar enormes proporciones. El tratamiento es la cirugía con resección completa para el control local de la enfermedad. Se presenta el caso de una paciente que acudió por hallazgo ecográfico de tumor intrabdominal en hipogastrio de origen no precisado, con evolución asintomática. Al examen físico se constató proceso tumoral palpable hacia hipogastrio de aproximadamente 3cm, suave, móvil, no superficial, no doloroso a la palpación. Se realizó laparotomía exploradora electiva, con omentectomía total por tumor en borde libre del omento mayor. La biopsia informó la presencia de liposarcoma mixoide de omento mayor. Debido a la poca frecuencia de este tipo de lesión se decide presentar el caso de esta paciente.

ABSTRACT Liposarcoma is a malignant tumor of mesodermal origin derived from adiposetissue. It is the most frequent of the soft tissue sarcomas in adults. Themost frequent location is in the lower extremities, the abdominal is rare.It reaches enormous proportions. Treatment is surgery with completerresection for local control of the disease. The case of a patient whopresented due to ultrasound finding of an intra-abdominal tumor in thehypogastrium of unspecified origin, with asymptomatic evolution, ispresented. Physical examination revealed a palpable tumor process towardsthe hypogastrium of approximately 3cm, smooth, mobile, non-superficial, notpainful on palpation. Elective exploratory laparotomy was performed, withtotal omentectomy for tumor on the free edge of the greater omentum. Biopsyreported the presence of myxoidliposarcoma of the greater omentum. Due tothe infrequency of this type of injury, it was decided to present the caseof this patient.

J Bone Miner Res ; 2020 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-32780899


The cardiovascular safety of denosumab has not yet been evaluated in a systematic review. This systematic review and meta-analysis sought to quantify the number of randomized controlled trials (RCTs) of denosumab (against comparators) reporting cardiovascular adverse events (CAEs) and examine the balance of CAEs between treatment arms. MEDLINE, Embase, and were searched from inception to October 26, 2019, for RCTs of denosumab versus comparators for any indication. Included trials were randomized, enrolled ≥100 participants, and reported bone-related outcomes. Primary outcome for analysis was all CAEs, a composite endpoint representing summation of all CAEs as reported by included trials. Secondary outcomes included major adverse cardiovascular events (MACE). Data were pooled using a fixed effects model to determine relative risk (RR) and 95% confidence interval (95% CI). Risk of bias was assessed using the Cochrane risk-of-bias tool. Of 554 records screened, 49 were included, while 36 reported CAEs. Twenty-seven included trials (12 eligible for meta-analysis) were conducted in 13,202 postmenopausal women. Compared with bisphosphonates, there was a 46% (95% CI 1.05 to 2.02) increase in CAEs (85/2136 events in denosumab-treated versus 58/2131 events in bisphosphonate-treated; seven trials). There was a similar imbalance in a five-point (stroke, myocardial infarction, cardiovascular death, heart failure, atrial fibrillation) MACE endpoint (28/2053 versus 12/2050; RR = 2.33 [1.19 to 4.56]). Compared with placebo-treated women, there was no imbalance in total CAEs (439/4725 events in denosumab versus 399/4467 in placebo; RR = 0.79 [0.41 to 1.52]; seven trials). No imbalance in total AEs (versus bisphosphonates: 0.98 [0.92 to 1.04]; versus placebo: 0.99 [0.98 to 1.01]) occurred. Other indications showed no statistically significant results. The excess CAEs in postmenopausal women treated with denosumab compared with bisphosphonates, but not placebo, indirectly supports claims that bisphosphonates may suppress CAEs. Future trials should use standardized CAE reporting to better describe cardiovascular effects of bone active medications. (PROSPERO: CRD42019135414.) © 2020 American Society for Bone and Mineral Research (ASBMR).

J Clin Endocrinol Metab ; 105(10)2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32717068


CONTEXT: The cardiovascular (CV) safety of oral bisphosphonates (oBPs) is uncertain. OBJECTIVE: Determine the risk of CV events in oBP users referred for bone mineral density (BMD) testing compared with matched controls. DESIGN: Cohort study. SETTING: Danish national prescription registry enriched with local hospital data from Odense. PARTICIPANTS: Individuals aged ≥45 years referred for BMD testing. EXPOSURE: oBP. OUTCOMES: Hospitalization for any CV event. Secondary study outcomes were specific CV events. Negative (inguinal hernia surgery and ingrown toenail) and positive (fragility fracture) control outcomes assessed systemic bias. Cox proportional hazards models were fitted to estimate hazard ratio (HR) and 95% confidence intervals. RESULTS: There were 2565 oBP users (82.6% women) and 4568 (82.3% women) propensity score-matched controls. Alendronate accounted for 96% of oBP prescription. A total of 406 (15.8%) CV events occurred in oBP users (rate = 73.48 [66.67-80.98]); rate = events divided by person-time; and 837 (18.3%) events in controls (rate = 104.73 [97.87-112.07]) with an adjusted HR of 0.68 (95% CI 0.60-0.77). Additional adjustment for BMD did not attenuate estimates (HR 0.67; 95% CI 0.58-0.78]. Similar results were seen for secondary outcomes where risk reductions were seen regarding atrial fibrillation, stroke, heart failure, and aneurysms. Positive and negative control outcome analyses identified minimal residual confounding. CONCLUSION: Oral BP users experienced a 33% reduced risk of CV events. This observational real-world study adds to a growing body of evidence for cardioprotection by oBP that warrants testing in a randomized setting.

Rom J Ophthalmol ; 64(2): 176-183, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32685784


Objective: To compare late mid-term results of two different surgical approaches of surface excimer laser ablation for myopic and astigmatic errors in contralateral eyes of the same patients. Methods: Prospective cohort study. A photorefractive keratectomy technique was performed on the right eye and single-step transepithelial photorefractive keratectomy on the left eye of the same patient, in 2012. Postoperative uncorrected and corrected visual acuities, manifest refraction, contrast sensitivity, objective scatter index, tear film stability assessed by serial measurements of objective scatter index and aberrometry as well as occurrence of haze, were compared between groups of eyes. Results: Thirty-two eyes of 16 patients with a mean time of follow-up of 35.2 +/ - 5.0 months (range 30-46 months) were evaluated. No significant differences were observed in postoperative results (visual acuity, spherical equivalent, defocus equivalent, higher-order aberrations, objective scatter index, tear film stability and contrast sensitivity). Contrast sensitivity tended to be better in transepithelial photorefractive keratectomy technique, under photopic lighting conditions without glare and mesopic conditions both with glare and without glare, however, no statistically significant differences were found. No eye presented corneal haze at the last examination. Conclusion: No statistically significant differences in visual acuity, refractive results, contrast sensitivity, objective scatter index, tear film stability or ocular aberrometry were observed between the two surface ablation techniques.

J Neural Eng ; 17(3): 036029, 2020 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-32454468


OBJECTIVE: Recording electrical activity from individual cells in vivo is a key technology for basic neuroscience and has growing clinical applications. To maximize the number of independent recording channels as well as the longevity, and quality of these recordings, researchers often turn to small and flexible electrodes that minimize tissue damage and can isolate signals from individual neurons. One challenge when creating these small electrodes, however, is to maintain a low interfacial impedance by applying a surface coating that is stable in tissue and does not significantly complicate the fabrication process. APPROACH: Here we use a high-pressure Pt sputtering process to create low-impedance electrodes at the wafer scale using standard microfabrication equipment. MAIN RESULTS: We find that direct-sputtered Pt provides a reliable and well-controlled porous coating that reduces the electrode impedance by 5-9 fold compared to flat Pt and is compatible with the microfabrication technologies used to create flexible electrodes. These porous Pt electrodes show reduced thermal noise that matches theoretical predictions. In addition, we show that these electrodes can be implanted into rat cortex, record single unit activity, and be removed all without disrupting the integrity of the coating. We also demonstrate that the shape of the electrode (in addition to the surface area) has a significant effect on the electrode impedance when the feature sizes are on the order of tens of microns. SIGNIFICANCE: Overall, porous Pt represents a promising method for manufacturing low-impedance electrodes that can be seamlessly integrated into existing processes for producing flexible neural probes.

Biomedica ; 40(1): 89-101, 2020 03 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32220166


Introduction: Traumatic brain injury is a leading worldwide cause of death and disability in young people. Severity classification is based on the Glasgow Coma Scale. However, the neurological worsening in an acute setting does not always correspond to the initial severity suggesting an underestimation of the real magnitude of the injury. Objective: To study the correlation between the initial severity according to the Glasgow Coma Scale and the patient outcome in the context of different clinical and tomography variables. Materials and methods: We analyzed a retrospective cohort of 490 patients with closed traumatic brain injury requiring a stay in the intensive care unit of two third-level hospitals in Barranquilla. The risk was estimated by calculating the OR (95% CI). The significance level was established at an alpha value of 0.05. Results: Forty-one percent of all patients required orotracheal intubation; 51.2% were initially classified with moderate trauma and 6,0% as mild. The delay in the aggressive management of the traumas affected mainly those patients with traumas classified as moderate in whom lethality increased to 100% when there was delay in the detection of the neurological worsening and in the establishment of the aggressive treatment beyond 4 to 8 hours while the lethality in patients who received this treatment within the first hour reduced to <20%. Conclusions: The risk of lethality in traumatic brain injury increases with the delayed detection of neurological worsening in an acute setting, especially when aggressive management is performed after the first hour post-trauma.

Biomédica (Bogotá) ; 40(1): 89-101, ene.-mar. 2020. tab, graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1089107


Resumen Introducción. El trauma craneoencefálico es una de las principales causas de muerte y discapacidad en adultos jóvenes. Su gravedad se define según la escala de coma de Glasgow. Sin embargo, el deterioro neurológico agudo no siempre concuerda con la gravedad inicial indicada por la escala, lo que implica una subestimación de la magnitud real de la lesión. Objetivo. Estudiar la correlación entre la gravedad inicial del trauma craneoencefálico según la escala de coma de Glasgow y la condición final del paciente, en el contexto de diferentes variables clínicas y de los hallazgos de la tomografía. Materiales y métodos. Se analizó una cohorte retrospectiva de 490 pacientes con trauma craneoencefálico cerrado que requirieron atención en la unidad de cuidados intensivos de dos centros de tercer nivel de Barranquilla. La estimación del riesgo se estableció con la razón de momios (odds ratio, OR) y un intervalo de confianza (IC) del 95 %. Se utilizó un alfa de 0,05 como nivel de significación. Resultados. El 41,0 % de los pacientes requirió intubación endotraqueal; el 51,2 % había presentado traumas inicialmente clasificados como moderados y, el 6,0 %, como leves. El retraso en la implementación de un tratamiento agresivo afectó principalmente a aquellos con trauma craneoencefálico moderado, en quienes la letalidad aumentó al 100 % cuando no se detectó a tiempo el deterioro neurológico y, por lo tanto, el tratamiento agresivo se demoró más de 4 a 8 horas. Por el contrario, la letalidad fue de menos de 20 % cuando se brindó el tratamiento agresivo en el curso de la primera hora después del trauma. Conclusiones. El riesgo de letalidad del trauma craneoencefálico aumentó cuando el deterioro neurológico se detectó tardíamente y el tratamiento agresivo se inició después de transcurrida la primera hora a partir del trauma.

Abstract Introduction: Traumatic brain injury is a leading worldwide cause of death and disability in young people. Severity classification is based on the Glasgow Coma Scale. However, the neurological worsening in an acute setting does not always correspond to the initial severity suggesting an underestimation of the real magnitude of the injury. Objective: To study the correlation between the initial severity according to the Glasgow Coma Scale and the patient outcome in the context of different clinical and tomography variables. Materials and methods: We analyzed a retrospective cohort of 490 patients with closed traumatic brain injury requiring a stay in the intensive care unit of two third-level hospitals in Barranquilla. The risk was estimated by calculating the OR (95% CI). The significance level was established at an alpha value of 0.05. Results: Forty-one percent of all patients required orotracheal intubation; 51.2% were initially classified with moderate trauma and 6,0% as mild. The delay in the aggressive management of the traumas affected mainly those patients with traumas classified as moderate in whom lethality increased to 100% when there was delay in the detection of the neurological worsening and in the establishment of the aggressive treatment beyond 4 to 8 hours while the lethality in patients who received this treatment within the first hour reduced to <20%. Conclusions: The risk of lethality in traumatic brain injury increases with the delayed detection of neurological worsening in an acute setting, especially when aggressive management is performed after the first hour post-trauma.

Repert. med. cir ; 29((Núm. Supl.1.)): 22-26, 2020.
Artigo em Inglês, Espanhol | LILACS, COLNAL | ID: biblio-1118357


El mundo vive una pandemia por un Coronavirus, llamado SARS-COV-2, que produce la COVID-19 (acrónimo del ingles coronavirus disease 2019), la cual ha generado un colapso en los sistemas de salud, haciendo que el manejo de otras enfermedades se convierta en un reto. De igual forma para los grupos oncológicos, la presencia de esta enfermedad, genera muchas dudas en la aplicación de los tratamientos estándares, los cuales se deben realizar lo antes posible, con el fin de ofrecer mejores resultados oncológicos. Se propone la creación de un índice ( COVID-19 Cáncer Index) , teniendo en cuenta variables clínicas, epidemiológicas y la disponibilidad de los recursos hospitalarios, útil para la toma de decisiones y el establecimiento del mejor tratamiento para una paciente con confirmación o alta sospecha de neoplasia ginecológica.

The world is experiencing a coronavirus pandemic called SARS-COV-2 which causes coronavirus disease 2019 (COVID 19). This has led to a collapse in health systems, making the management of other diseases a challenge. Similarly, the presence of this disease generates many doubts for oncological groups regarding the provision of standard treatments, which should be carried out as soon as possible, in order to ensure better oncological outcomes. We propose the creation of an index (COVID 19 Cancer Index) taking into account clinical and epidemiological variables and the availability of hospital resources, which are useful for decision making and determining the best treatment for a patient with confirmed or strongly suspected gynecological neoplasia.

Humanos , Infecções por Coronavirus , Neoplasias dos Genitais Femininos , Pandemias , Oncologia , Neoplasias
Edumecentro ; 11(3): 174-189, jul.-set. 2019. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1089956


RESUMEN Fundamento: en el curso 2017-2018 se introdujo la asignatura Sangre y Sistema Inmune en el tercer semestre de la carrera de Medicina, según el nuevo plan de estudio. Objetivos: identificar el grado de satisfacción y desempeño de los estudiantes en la asignatura Sangre y Sistema Inmune de recién incorporación en el Plan de Estudios D. Método: se realizó un estudio descriptivo en la Universidad de Ciencias Médicas de Villa Clara en el curso académico 2017-2018. Se utilizaron métodos teóricos: análisis-síntesis e inducción-deducción, empíricos: la encuesta en forma de cuestionario en dos momentos concretos del semestre (cuarta y decimoquinta semanas), y matemático-estadísticos para el procesamiento de los datos. Resultados: en sentido general la introducción de la asignatura Sangre y Sistema Inmune en el currículo tuvo un nivel adecuado de aceptación por los alumnos y este evolucionó de forma positiva en la medida en que transcurrió el curso. En los casos de insatisfacción, la principal causa estuvo vinculada a la dificultad de los temas impartidos. Existe preferencia por las clases talleres y prácticas de laboratorio, y el trabajo de curso como evaluación final, y no con un examen teórico. Conclusiones: el nivel de satisfacción expresado por los alumnos con la asignatura fue adecuado, no así el desempeño ya que la mayoría reconocieron no poseer los conocimientos básicos sobre su contenido, aspectos que se tuvieron en cuenta en su posterior impartición.

ABSTRACT Background: in the 2017-2018 academic year, the Blood and Immune System subject was introduced in the third semester of the Medicine degree, according to the new study plan. Objectives: to identify the degree of satisfaction and performance of students in the Blood and Immune System subject of recent incorporation in the Study Plan D. Methods: a descriptive study was carried out at Villa Clara University of Medical Sciences in the academic year 2017-2018. Theoretical methods were used: analysis-synthesis and induction-deduction, empirical ones: the survey in the form of a questionnaire in two specific moments of the semester (fourth and fifteenth weeks), and mathematical-statistics for data processing. Results: in general, the introduction of the Blood and Immune System subject in the curriculum had an adequate level of acceptance by the students and this evolved in a positive way to the extent that the course lasted. In cases of dissatisfaction, the main cause was linked to the difficulty of the subjects taught. There is a preference for workshops and laboratory practices, and a course project work as a final evaluation, and not with a theoretical exam. Conclusions: the level of satisfaction expressed by the students with the subject was adequate, not so the performance since most acknowledged not having the basic knowledge about its content, aspects that were taken into account in its subsequent teaching.

Estudantes de Medicina , Educação Médica , Estudos Interdisciplinares , Aprendizagem
BMJ Open ; 9(4): e026232, 2019 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-30944137


INTRODUCTION: Abdominal aortic calcification (AAC) is associated with low bone mass and increased fracture risk. Two previous meta-analyses have investigated the association between AAC and fracture. However, these meta-analyses only identified articles until December 2016, undertook limited searches and did not explore potential sources of between-study heterogeneity. We aim to undertake a sensitive and comprehensive assessment of the relationship between AAC, bone mineral density (BMD) as well as prevalent and incident fractures. METHODS: We will search MEDLINE, EMBASE, Web of Science core collection and Google Scholar (top 200 articles sorted by relevance) from their inception to 1 June 2018. Reference lists of included studies and previous systematic reviews will be hand searched for additional eligible studies. Retrospective and prospective cohort studies (cross-sectional, case-control and longitudinal) reporting the association between AAC, BMD and fracture at any site will be included. At least two investigators will independently: (A) evaluate study eligibility and extract data, with a third investigator to adjudicate when discrepancies occur, (B) assess study quality by the Newcastle-Ottawa Scale for each cohort/study. The meta-analysis will be reported in adherence to the Meta-analysis of Observational Studies in Epidemiology criteria. AAC will be grouped as either: (1) AAC present or absent, (2) AAC categorised as 'low' (referent-lowest reported group) versus 'high' (all other groups) or (3) dose-response when AAC was assessed in ≥3 groups. Where primary event data were reported in individual studies, pooled risk differences and risk ratios with 95% CI will be calculated, from which, a summary estimate will be determined using DerSimonian-Laird random effects models. For the AAC and BMD pooled analyses, estimates will be expressed as standardised mean difference with 95% CI. We will examine the likelihood of publication bias and where possible, investigate potential reasons for between-study heterogeneity using subgroup analyses and meta-regression. ETHICS AND DISSEMINATION: The study will be submitted to a peer- reviewed journal and disseminated via research presentations. PROSPERO REGISTRATION NUMBER: CRD42018088019.

Aorta Abdominal/diagnóstico por imagem , Doenças da Aorta/epidemiologia , Densidade Óssea , Fraturas Ósseas/epidemiologia , Calcificação Vascular/epidemiologia , Doenças da Aorta/diagnóstico , Comorbidade , Saúde Global , Humanos , Prevalência , Calcificação Vascular/diagnóstico
Sci Rep ; 9(1): 3182, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30816194


BiFeO3 (BFO) nanoparticles (NPs) were synthesized using the sol-gel method at different calcination temperatures from 400 °C to 600 °C. XRD studies have confirmed that all BFO NPs show distorted rhombohedral crystals that match the R3c space group. We found evidence of local structural strain that develops with increasing particle size as suggested by TEM and Raman spectroscopy measurements. Magnetic measurements suggest that NPs have two distinct regimes: a ferromagnetic-like one at low temperatures and a superparamagnetic-like one at room temperature. The crossover temperature increases with NPs size, suggesting a size-dependent blocking magnetic regime. Similarly, local piezoelectric measurements at room temperature in single NP have confirmed a ferroelectric order with a NP size-dependent d33 coefficient. An analysis of both the ferroelectric and the magnetic results suggest that ferromagnetism and ferroelectricity coexist at room temperature in NPs. Our results lead to the possibility of tailoring the ferroic order in multifunctional materials by means of NP size.

CorSalud ; 11(1): 11-20, ene.-mar. 2019. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1089705


RESUMEN Introducción: El sistema nervioso autónomo desempeña un papel importante en los reajustes cardiovasculares al ejercicio. En la hiperreactividad cardiovascular existe una mayor sensibilidad del sistema simpático ante diferentes estímulos estresantes. Objetivo: Determinar las características del control autonómico cardíaco en adultos jóvenes con diferentes grados de reactividad cardiovascular en condiciones basales y durante el ejercicio isométrico. Método: La muestra estuvo constituida por 97 individuos de ambos sexos, y se dividió en tres grupos: normorreactivos, hiperreactivos y con respuesta hipertensiva, de acuerdo a la respuesta presora a la prueba del peso sostenido. A todos los individuos se les realizó un estudio de variabilidad de la frecuencia cardíaca en reposo y durante la prueba isométrica. Se estudiaron las variables en el dominio de la frecuencia: baja, alta, relación baja/alta en reposo, y los parámetros del diagrama de Poincaré en reposo y durante el ejercicio (valores de desviación estándar 1 [SD1], 2 [SD2], y la razón entre ambos). Resultados: En estado basal los individuos hiperreactivos y con respuesta hipertensiva presentaron un predominio simpático sobre la función cardíaca y una menor variabilidad de la frecuencia cardíaca. Durante el ejercicio isométrico disminuyeron los valores de los ejes SD1 y SD2 en todos los grupos y la razón SD1/SD2 decreció en individuos normorreactivos y con respuesta hipertensiva; pero apenas se modificó en los hiperreactivos. Conclusiones: En los individuos con hiperreactividad cardiovascular ya está presente un desbalance autonómico en estado basal y existe una reducción de la modulación autonómica vagal durante el ejercicio, que puede favorecer el desarrollo de la hipertensión arterial.

ABSTRACT Introduction: The autonomic nervous system plays an important role in cardiovascular readjustments to exercise. In cardiovascular hyperreactivity there is a greater sensitivity of the sympathetic system to different stressors. Objective: To determine the characteristics of cardiac autonomic control in young adults with different degrees of cardiovascular reactivity under basal conditions and during isometric exercise. Method: The sample consisted of 97 individuals of both sexes, and was divided into three groups: normoreactive, hyperreactive and with hypertensive response, according to the pressor response to weight-bearing tests. The individuals underwent a complete study of heart rate variability at rest and during isometric test. The frequency domain for the variables was: low, high, low/high resting ratio, and the parameters of Poincaré plots at rest and during exercise (values of standard deviation 1 [SD1], 2 [SD2], and the reason between them). Results: Under basal conditions, hyperreactive individuals with a hypertensive response had a sympathetic predominance over cardiac function and lower heart rate variability. During the isometric exercise SD1 and SD2 axes values decreased in all groups and SD1/SD2 ratio decreased in normoreactive individuals with hypertensive response; but it was hardly modified in those hyper-reactive. Conclusions: Individuals with cardiovascular hyperreactivity have a prior autonomic imbalance under basal conditions and a reduction of autonomic vagal modulation during exercise that may favor the development of arterial hypertension.

Hiper-Reatividade Brônquica , Exercício Físico , Frequência Cardíaca , Contração Isométrica
J Bone Miner Res ; 34(1): 3-21, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30677181


Vertebral augmentation is among the current standards of care to reduce pain in patients with vertebral fractures (VF), yet a lack of consensus regarding efficacy and safety of percutaneous vertebroplasty and kyphoplasty raises questions on what basis clinicians should choose one therapy over another. Given the lack of consensus in the field, the American Society for Bone and Mineral Research (ASBMR) leadership charged this Task Force to address key questions on the efficacy and safety of vertebral augmentation and other nonpharmacological approaches for the treatment of pain after VF. This report details the findings and recommendations of this Task Force. For patients with acutely painful VF, percutaneous vertebroplasty provides no demonstrable clinically significant benefit over placebo. Results did not differ according to duration of pain. There is also insufficient evidence to support kyphoplasty over nonsurgical management, percutaneous vertebroplasty, vertebral body stenting, or KIVA®. There is limited evidence to determine the risk of incident VF or serious adverse effects (AE) related to either percutaneous vertebroplasty or kyphoplasty. No recommendation can be made about harms, but they cannot be excluded. For patients with painful VF, it is unclear whether spinal bracing improves physical function, disability, or quality of life. Exercise may improve mobility and may reduce pain and fear of falling but does not reduce falls or fractures in individuals with VF. General and intervention-specific research recommendations stress the need to reduce study bias and address methodological flaws in study design and data collection. This includes the need for larger sample sizes, inclusion of a placebo control, more data on serious AE, and more research on nonpharmacologic interventions. Routine use of vertebral augmentation is not supported by current evidence. When it is offered, patients should be fully informed about the evidence. Anti-osteoporotic medications reduce the risk of subsequent vertebral fractures by 40-70%. © 2018 American Society for Bone and Mineral Research.

Dor nas Costas/cirurgia , Fraturas por Compressão/cirurgia , Cifoplastia , Fraturas por Osteoporose/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia , Comitês Consultivos , Dor nas Costas/patologia , Dor nas Costas/fisiopatologia , Feminino , Fraturas por Compressão/patologia , Fraturas por Compressão/fisiopatologia , Humanos , Masculino , Fraturas por Osteoporose/patologia , Fraturas por Osteoporose/fisiopatologia , Qualidade de Vida , Fraturas da Coluna Vertebral/patologia , Fraturas da Coluna Vertebral/fisiopatologia , Coluna Vertebral/patologia , Coluna Vertebral/fisiopatologia , Coluna Vertebral/cirurgia
Curr Osteoporos Rep ; 16(6): 674-692, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30328552


PURPOSE OF REVIEW: Patients with chronic kidney disease (CKD) have a greatly increased fracture risk compared with the general population. Gonadal hormones have an important influence on bone mineral density (BMD) and fracture risk, and hormone therapies can significantly improve these outcomes. Gonadal dysfunction is a frequent finding in patients with CKD; yet, little is known about the impact of gonadal hormones in the pathogenesis and treatment of bone health in patients with CKD. This systematic review and meta-analysis aimed to examine the effects of gonadal hormones and hormone therapies on bone outcomes in men and women with CKD. METHODS: EMBASE, MEDLINE, SCOPUS, and clinical trial registries were systematically searched from inception to February 14, 2018 for studies that assessed gonadal hormones or hormone treatments with bone outcomes in patients with CKD stage 3-5D. Two independent reviewers screened the titles and abstracts of search results according to inclusion criteria and assessed study quality and risk of bias using validated assessment tools. RECENT FINDINGS: Thirteen studies met the inclusion criteria. Six moderate-to-high quality observational studies showed inconsistent association between any gonadal hormone and bone outcomes, limited by significant study heterogeneity. Five moderate-high risk of bias interventional studies examined treatment with selective oestrogen receptor modulators in post-menopausal women (four using raloxifene and one bazedoxifene) and demonstrated variable effects on BMD and fracture outcomes. Meta-analysis of raloxifene treatment in post-menopausal women demonstrated improvement in lumbar spine (SMD 3.30; 95% CI 3.21-3.38) and femoral neck (SMD 3.29; 95% CI 3.21-3.36) BMD compared with placebo. Transdermal oestradiol/norethisterone in pre-menopausal women receiving dialysis (n = 1 study), demonstrated BMD improvement over 12 months. Testosterone treatment for 6 months in dialysis-dependant men (n = 1 study) did not improve BMD. There is evidence that raloxifene treatment may be beneficial in improving BMD in post-menopausal women with CKD. There is insufficient evidence for other hormone treatments in men or women. Despite high fracture rates and frequent gonadal dysfunction in patients with CKD, significant evidence gaps exist, and well-designed studies are required to specifically assess the impact of gonadal status in the pathogenesis of CKD-related bone fragility and its treatment.

Conservadores da Densidade Óssea/uso terapêutico , Densidade Óssea/fisiologia , Hormônios Gonadais/metabolismo , Osteoporose/tratamento farmacológico , Insuficiência Renal Crônica/complicações , Humanos , Osteoporose/etiologia , Osteoporose/metabolismo , Insuficiência Renal Crônica/metabolismo
Arch Osteoporos ; 13(1): 101, 2018 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-30242518


The risk of mortality associated with high dietary calcium is uncertain. Unlike a highly publicised study in Swedish women, high dietary calcium intake in men-not women-was associated with increased all-cause mortality. PURPOSE: The association of dietary calcium with mortality is controversial. A study of women from the Swedish Mammography Cohort (SMC) suggested higher calcium was associated with higher mortality risk, whilst a study of Australian adults from the Melbourne Collaborative Cohort Study (MCCS) suggested higher intakes were associated with lower mortality risk. Thus, we aimed to perform a sex-specific re-analysis of the MCCS to evaluate the association of dietary calcium with mortality outcomes and directly compare hazard estimates (95% confidence intervals) in women with those from the SMC. METHODS: A prospective cohort study of community-dwelling Australian adults was conducted, in which 34,627 individuals (women 20,834 (60.2%); mean ± SD, age = 54 ± 8 years) were included at baseline after excluding those with prevalent cardiovascular (CV) disease, cancer or incomplete data. Energy-adjusted dietary calcium was categorised into the following levels of consumption (mg/day): < 600, 600-999, 1000-1399 and ≥ 1400. Mortality from all-causes, any cardiovascular disease and myocardial infarction was determined. Mortality hazards relative to intakes were estimated to be of 600-999 mg/day. RESULTS: In women, hazard estimates for calcium intake of ≥ 1400 mg/day did not reach significance for all-cause (HR = 0.85; 0.66, 1.10) or CV (HR = 1.10; 0.69, 1.81) mortality in adjusted models. In men, intakes of ≥ 1400 mg/day were associated with a 42% increased all-cause mortality risk (HR = 1.42; 1.02, 1.99). There was a trend toward increased CV mortality (HR = 1.83; 0.94, 3.55). CONCLUSION: Contrary to findings from a similar study conducted in Swedish women, Australian women, after adjustment for cofounders showed no increase in mortality risk with high calcium intakes possibly reflecting differences in calcium handling dynamics, diet or lifestyle factors between the two countries. We identified an increased risk for men.

Cálcio na Dieta/análise , Dieta/mortalidade , Fatores Sexuais , Adulto , Idoso , Doenças Cardiovasculares/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Estudos Prospectivos , Vitória
Calcif Tissue Int ; 103(6): 589-598, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30039226


The objective of the study was to determine the association between AAC and neuromuscular function over 5 years. Participants in this study were ambulant women over 70 years old residing in Perth, Western Australia who participated in the Calcium Intake Fracture Outcomes Study, a randomised controlled trial of calcium supplementation. 1046 women (mean age = 74.9 ± 2.6 years; BMI = 27.1 ± 4.4 kg/m2) were included. Lateral spine images captured during bone density testing were scored for AAC (AAC24; 0-24) at baseline. Severe AAC (AACsev) was defined using established cut points (AAC24 ≥ 6). At baseline and follow-up, isometric grip strength was assessed using a dynamometer. Mobility was assessed by the Timed-Up-and-Go (TUG) test. Using pre-defined criteria, muscle weakness was considered as grip strength < 22 kg and poor mobility defined as TUG > 10.2 s. A subset of women had appendicular lean mass (ALM) determined by dual-energy X-ray absorptiometry at baseline and follow-up (n = 261). AACsev was evident in 193 (18.5%) women. Average decline in grip strength after 5 years was greater in those with AACsev than those without (3.6 ± 3.7 vs. 2.9 ± 4.2 kg; p = 0.034). This remained significant after adjustment for age, treatment allocation, diabetes, smoking history, renal function, medical record-derived prevalent vascular disease, BMI and physical activity (ß = - 0.184; 95% confidence interval: - 0.361, - 0.008; p = 0.040). AACsev was not associated with 5-year changes in TUG or ALM in univariable or multivariable analyses (all p > 0.05). In older women, severe aortic calcification was associated with greater 5-year decline in muscle strength, but not TUG or ALM. These findings support the concept that vascular disease may have an effect on the loss of muscular strength.

Doenças da Aorta/complicações , Aterosclerose/complicações , Calcinose/complicações , Força da Mão/fisiologia , Idoso , Feminino , Humanos , Estudos Longitudinais , Ensaios Clínicos Controlados Aleatórios como Assunto