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1.
Medicine (Baltimore) ; 100(16): e25476, 2021 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-33879680

RESUMO

BACKGROUND: Knee osteoarthritis (KOA) is a chronic and degenerative bone and joint disease, with KOA, cartilage degeneration, destruction and subchondral bone remodeling as the main pathological features. Its clinical symptoms are knee pain, swelling, limited activity, and long course of disease can cause joint deformities. At present, the early treatment of Western medicine is mainly the use of nonsteroidal drugs for anti-inflammation and removing pain, but because the efficacy of these drugs is unstable, the disease is easy to repeat after treatment, and the clinical effect is not good. Although Biqi capsule has advantages in the treatment of KOA, there is a lack of standard clinical studies to verify it, so the purpose of this randomized controlled study is to evaluate the efficacy and safety of Biqi capsule in the treatment of KOA. METHODS: This is a prospective randomized controlled trial to study the efficacy and safety of Biqi capsule in the treatment of KOA. The patients were randomly divided into a treatment group and a control group according to 1:1. Among them, treatment group: Biqi capsule combined with diclofenac sodium sustained release tablets; Control group: Diclofenac sodium sustained-release tablets alone. Both groups were treated with standard treatment for 2 weeks and were followed up for 30 days to pay attention to the efficacy and safety indexes. Observation indicators included: the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Hospital for Special Surgery Knee Score (HSS), liver and kidney function, adverse reactions, and so on. SPSS 25.0 software is used for data analysis. DISCUSSION: This study will evaluate the efficacy and safety of Biqi capsule in the treatment of KOA, and the results of this experiment will provide a clinical basis for Biqi capsule in the treatment of KOA. TRIAL REGISTRATION: OSF Registration number: DOI 10.17605/OSF.IO/6HB9D.


Assuntos
Artralgia/tratamento farmacológico , Diclofenaco/administração & dosagem , Medicamentos de Ervas Chinesas/administração & dosagem , Osteoartrite do Joelho/tratamento farmacológico , Adulto , Artralgia/diagnóstico , Artralgia/etiologia , Cápsulas , Preparações de Ação Retardada/administração & dosagem , Preparações de Ação Retardada/efeitos adversos , Diclofenaco/efeitos adversos , Quimioterapia Combinada , Medicamentos de Ervas Chinesas/efeitos adversos , Feminino , Seguimentos , Humanos , Articulação do Joelho/efeitos dos fármacos , Masculino , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/diagnóstico , Medição da Dor/estatística & dados numéricos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Comprimidos , Resultado do Tratamento
2.
Medicine (Baltimore) ; 100(10): e24965, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725860

RESUMO

BACKGROUND: There have been no published randomized clinical trial to assess the clinical outcomes between the articular-sided and bursal-sided tears. Therefore, a comparative analysis of evaluating and comparing the functional outcomes following arthroscopic repair of bursal-sided versus articular-sided partial-thickness rotator cuff tearsis essential. METHODS: This study is a present randomized controlled trial which is conducted in our hospital. Consecutive patients with symptomatic articular-sided or bursal-sided partial-thickness rotator cuff tears underwent arthroscopic repair between June 2020 and January 2022. The institutional review board approved the study proposal (with number 10012030), and informed consent was obtained from all patients. Inclusion criteria were existence of an articular- or bursal-sided tear involving <50% of the tendon thickness-confirmed intraoperatively and treated with arthroscopic debridement with or without other decompression surgery (acromioplasty/distal clavicle resection)-and a minimum follow-up of 2 years. All patients followed the same postoperative rehabilitation program. The patients were assessed at baseline preoperatively, and at 1 year and 2 years postoperatively. Outcome parameters were measured at each respective follow-up, which included active range of motion in forward flexion and abduction of the affected shoulder, pain score as measured on the Numeric Pain Rating Scale, as well as outcome scores in terms of the Constant-Murley Score, and Oxford Shoulder Score. RESULTS: Table 1 and Table 2 describe the data indicators that this article wants to evaluate and collect. CONCLUSIONS: We hypothesize that both groups of patients will show improvement in range of motion, functional outcome scores, and pain at 2 years, and that results would be similar between the two groups. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry6496).


Assuntos
Artralgia/cirurgia , Artroscopia , Lesões do Manguito Rotador/cirurgia , Manguito Rotador/cirurgia , Articulação do Ombro/fisiopatologia , Artralgia/diagnóstico , Artralgia/etiologia , Artralgia/fisiopatologia , Braquetes , Desbridamento/métodos , Descompressão Cirúrgica/métodos , Feminino , Seguimentos , Humanos , Masculino , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Lesões do Manguito Rotador/complicações , Lesões do Manguito Rotador/fisiopatologia , Lesões do Manguito Rotador/reabilitação , Articulação do Ombro/cirurgia , Resultado do Tratamento
3.
BMJ Case Rep ; 14(3)2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33653867

RESUMO

A previously healthy 53-year-old man was hospitalised for 12 days due to COVID-19 with shortness of breath. A few days after discharge from hospital, the patient developed fever and severe pain in several joints in the lower extremities. The pain was so severe that the patient was unable to stand on his feet. Synovial fluid from the right-side knee contained a high number of polynuclear cells and a few mononuclear cells. Microscopy, culture and PCR tests for bacterial infection were all negative. Furthermore, the patient tested negative for rheumatoid factor, anti-cyclic citrullinated peptide and human leukocyte antigen (HLA)-B27. Thus, the condition was compatible with reactive arthritis. The condition improved markedly after a few days' treatment with non-steroid anti-inflammatory drugs and prednisolone.


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Artrite Reativa , Artrite , Prednisolona/administração & dosagem , Líquido Sinovial , Anti-Inflamatórios/administração & dosagem , Artralgia/diagnóstico , Artralgia/etiologia , Artrite/tratamento farmacológico , Artrite/etiologia , Artrite/fisiopatologia , Artrite Reativa/diagnóstico , Artrite Reativa/tratamento farmacológico , Artrite Reativa/fisiopatologia , Artrite Reativa/virologia , Artrite Reumatoide/diagnóstico , Autoanticorpos/análise , /fisiopatologia , Diagnóstico Diferencial , Humanos , Articulação do Joelho/diagnóstico por imagem , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Radiografia/métodos , Líquido Sinovial/citologia , Líquido Sinovial/imunologia , Resultado do Tratamento
4.
Medicine (Baltimore) ; 100(13): e25382, 2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33787644

RESUMO

BACKGROUND: A recent trend in the field of primary knee osteoarthritis suggests that elastic tape (e.g., K-tape) relieves pressure on the joint by increasing tension on fascia. Elastic tape (ET) is expected to decrease pain and help patients to recover faster. OBJECTIVE: This systematic review aims to analyze the efficacy of this method on pain in patients with knee osteoarthritis by using The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. DATA SOURCES: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard for reporting systematic reviews of qualitative and quantitative evidence, we used 3 electronic databases, PubMed, Cochrane, and EBSCO, and grey literature was included. STUDY ELIGIBILITY CRITERIA: Articles were screened for duplicates, screened for inclusion and exclusion criteria, and critically appraised. PARTICIPANTS AND INTERVENTION: People older than 45 years old with primary osteoarthritis (OA) and application of ET. STUDY APPRAISAL AND SYNTHESIS METHODS: 2005 Oxford standard. RESULTS: Amongst all the papers found, 6 Randomized Control Trials (RCT) for a total of 392 participants met the criteria and were included in our review. Three papers out of the 6 RCT had low risks of bias. When the ET was compared to sham taping, the results show no to moderate decreases of WOMAC scores in patients with primary knee osteoarthritis. LIMITATIONS: We focused on a single index test (WOMAC) and could not perform meta-analyses. CONCLUSION AND IMPLICATIONS OF KEY FINDINGS: Although ET does not provide strong adverse outcomes, our data do not support the use of ET as a treatment alone because of too slight reductions of the WOMAC score for reaching clinical efficiency. Thus, our systematic review shows no strong evidence regarding the use of elastic taping for pain improvement in patients with primary knee osteoarthritis.


Assuntos
Artralgia/terapia , Bandagens Compressivas , Osteoartrite do Joelho/complicações , Manejo da Dor/métodos , Artralgia/diagnóstico , Artralgia/etiologia , Humanos , Osteoartrite do Joelho/terapia , Medição da Dor/estatística & dados numéricos , Resultado do Tratamento
5.
Cochrane Database Syst Rev ; 2: CD013665, 2021 02 23.
Artigo em Inglês | MEDLINE | ID: mdl-33620086

RESUMO

BACKGROUND: The clinical implications of SARS-CoV-2 infection are highly variable. Some people with SARS-CoV-2 infection remain asymptomatic, whilst the infection can cause mild to moderate COVID-19 and COVID-19 pneumonia in others. This can lead to some people requiring intensive care support and, in some cases, to death, especially in older adults. Symptoms such as fever, cough, or loss of smell or taste, and signs such as oxygen saturation are the first and most readily available diagnostic information. Such information could be used to either rule out COVID-19, or select patients for further testing. This is an update of this review, the first version of which published in July 2020. OBJECTIVES: To assess the diagnostic accuracy of signs and symptoms to determine if a person presenting in primary care or to hospital outpatient settings, such as the emergency department or dedicated COVID-19 clinics, has COVID-19. SEARCH METHODS: For this review iteration we undertook electronic searches up to 15 July 2020 in the Cochrane COVID-19 Study Register and the University of Bern living search database. In addition, we checked repositories of COVID-19 publications. We did not apply any language restrictions. SELECTION CRITERIA: Studies were eligible if they included patients with clinically suspected COVID-19, or if they recruited known cases with COVID-19 and controls without COVID-19. Studies were eligible when they recruited patients presenting to primary care or hospital outpatient settings. Studies in hospitalised patients were only included if symptoms and signs were recorded on admission or at presentation. Studies including patients who contracted SARS-CoV-2 infection while admitted to hospital were not eligible. The minimum eligible sample size of studies was 10 participants. All signs and symptoms were eligible for this review, including individual signs and symptoms or combinations. We accepted a range of reference standards. DATA COLLECTION AND ANALYSIS: Pairs of review authors independently selected all studies, at both title and abstract stage and full-text stage. They resolved any disagreements by discussion with a third review author. Two review authors independently extracted data and resolved disagreements by discussion with a third review author. Two review authors independently assessed risk of bias using the Quality Assessment tool for Diagnostic Accuracy Studies (QUADAS-2) checklist. We presented sensitivity and specificity in paired forest plots, in receiver operating characteristic space and in dumbbell plots. We estimated summary parameters using a bivariate random-effects meta-analysis whenever five or more primary studies were available, and whenever heterogeneity across studies was deemed acceptable. MAIN RESULTS: We identified 44 studies including 26,884 participants in total. Prevalence of COVID-19 varied from 3% to 71% with a median of 21%. There were three studies from primary care settings (1824 participants), nine studies from outpatient testing centres (10,717 participants), 12 studies performed in hospital outpatient wards (5061 participants), seven studies in hospitalised patients (1048 participants), 10 studies in the emergency department (3173 participants), and three studies in which the setting was not specified (5061 participants). The studies did not clearly distinguish mild from severe COVID-19, so we present the results for all disease severities together. Fifteen studies had a high risk of bias for selection of participants because inclusion in the studies depended on the applicable testing and referral protocols, which included many of the signs and symptoms under study in this review. This may have especially influenced the sensitivity of those features used in referral protocols, such as fever and cough. Five studies only included participants with pneumonia on imaging, suggesting that this is a highly selected population. In an additional 12 studies, we were unable to assess the risk for selection bias. This makes it very difficult to judge the validity of the diagnostic accuracy of the signs and symptoms from these included studies. The applicability of the results of this review update improved in comparison with the original review. A greater proportion of studies included participants who presented to outpatient settings, which is where the majority of clinical assessments for COVID-19 take place. However, still none of the studies presented any data on children separately, and only one focused specifically on older adults. We found data on 84 signs and symptoms. Results were highly variable across studies. Most had very low sensitivity and high specificity. Only cough (25 studies) and fever (7 studies) had a pooled sensitivity of at least 50% but specificities were moderate to low. Cough had a sensitivity of 67.4% (95% confidence interval (CI) 59.8% to 74.1%) and specificity of 35.0% (95% CI 28.7% to 41.9%). Fever had a sensitivity of 53.8% (95% CI 35.0% to 71.7%) and a specificity of 67.4% (95% CI 53.3% to 78.9%). The pooled positive likelihood ratio of cough was only 1.04 (95% CI 0.97 to 1.11) and that of fever 1.65 (95% CI 1.41 to 1.93). Anosmia alone (11 studies), ageusia alone (6 studies), and anosmia or ageusia (6 studies) had sensitivities below 50% but specificities over 90%. Anosmia had a pooled sensitivity of 28.0% (95% CI 17.7% to 41.3%) and a specificity of 93.4% (95% CI 88.3% to 96.4%). Ageusia had a pooled sensitivity of 24.8% (95% CI 12.4% to 43.5%) and a specificity of 91.4% (95% CI 81.3% to 96.3%). Anosmia or ageusia had a pooled sensitivity of 41.0% (95% CI 27.0% to 56.6%) and a specificity of 90.5% (95% CI 81.2% to 95.4%). The pooled positive likelihood ratios of anosmia alone and anosmia or ageusia were 4.25 (95% CI 3.17 to 5.71) and 4.31 (95% CI 3.00 to 6.18) respectively, which is just below our arbitrary definition of a 'red flag', that is, a positive likelihood ratio of at least 5. The pooled positive likelihood ratio of ageusia alone was only 2.88 (95% CI 2.02 to 4.09). Only two studies assessed combinations of different signs and symptoms, mostly combining fever and cough with other symptoms. These combinations had a specificity above 80%, but at the cost of very low sensitivity (< 30%). AUTHORS' CONCLUSIONS: The majority of individual signs and symptoms included in this review appear to have very poor diagnostic accuracy, although this should be interpreted in the context of selection bias and heterogeneity between studies. Based on currently available data, neither absence nor presence of signs or symptoms are accurate enough to rule in or rule out COVID-19. The presence of anosmia or ageusia may be useful as a red flag for COVID-19. The presence of fever or cough, given their high sensitivities, may also be useful to identify people for further testing. Prospective studies in an unselected population presenting to primary care or hospital outpatient settings, examining combinations of signs and symptoms to evaluate the syndromic presentation of COVID-19, are still urgently needed. Results from such studies could inform subsequent management decisions.


Assuntos
Assistência Ambulatorial , Atenção Primária à Saúde , Avaliação de Sintomas , Ageusia/diagnóstico , Ageusia/etiologia , /etiologia , Artralgia/diagnóstico , Artralgia/etiologia , Viés , /epidemiologia , Tosse/diagnóstico , Tosse/etiologia , Diarreia/diagnóstico , Diarreia/etiologia , Dispneia/diagnóstico , Dispneia/etiologia , Fadiga/diagnóstico , Fadiga/etiologia , Febre/diagnóstico , Febre/etiologia , Cefaleia/diagnóstico , Cefaleia/etiologia , Humanos , Mialgia/diagnóstico , Mialgia/etiologia , Ambulatório Hospitalar/estatística & dados numéricos , Pandemias , Exame Físico , Viés de Seleção , Avaliação de Sintomas/classificação , Avaliação de Sintomas/estatística & dados numéricos
7.
Spine (Phila Pa 1976) ; 46(5): 285-293, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33534439

RESUMO

STUDY DESIGN: Multicenter double-blind randomized sham-controlled trial. OBJECTIVE: To assess the efficacy of radiofrequency (RF) denervation of the cervical facet joints in chronic cervical facet joint pain. SUMMARY OF BACKGROUND DATA: One randomized controlled trial showed efficacy of RF denervation in whiplash-associated disease. There are no randomized controlled trials on RF denervation in patients with chronic cervical facet joint pain. METHODS: Patients were randomized to receive RF denervation combined with bupivacaine (intervention group) or bupivacaine alone (control group). In the intervention group, an RF thermal lesion was made at the cervical medial branches after the injection of bupivacaine. The primary outcome was measured at 6 months and consisted of pain intensity, self-reported treatment effect, improvement on the Neck Disability Index, and the use of pain medication. Duration of effect was determined using telephone interviews. RESULTS: We included 76 patients. In the intervention group, 55.6% showed > 30% pain decrease versus 51.3% in the control group (P = 0.711); 50.0% reported success on the Patients' Global Impression of Change in the intervention group versus 41.0% (P = 0.435); the Neck Disability Index was 15.0 ±â€Š8.7 in the intervention group compared with 16.5 ±â€Š7.2 (P = 0.432), the need for pain medication did not differ significantly between groups (P = 0.461). The median time to end of treatment success for patients in the RF group was 42 months, compared with 12 months in the bupivacaine group (P = 0.014). CONCLUSIONS: We did not observe significant differences between RF denervation combined with injection of local anesthesia compared with local anesthesia only at 6 months follow-up. We found a difference in the long-term effect after 6 months follow-up in favor of the RF treatment.Level of Evidence: 2.


Assuntos
Artralgia/terapia , Bupivacaína/administração & dosagem , Vértebras Cervicais/patologia , Denervação/métodos , Cervicalgia/terapia , Articulação Zigapofisária/patologia , Idoso , Anestésicos Locais/administração & dosagem , Artralgia/diagnóstico , Vértebras Cervicais/efeitos dos fármacos , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cervicalgia/diagnóstico , Fatores de Tempo , Resultado do Tratamento , Articulação Zigapofisária/efeitos dos fármacos
8.
Medicine (Baltimore) ; 100(5): e24252, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592868

RESUMO

BACKGROUND: The popularity of dietary supplements for knee osteoarthritis (OA) management is on the rise; however, their effects are still debated. METHODS: This study aimed to investigate the effect of an oral low molecular weight liquid hyaluronic acid supplement in the treatment of knee OA patients with mild knee pain (visual analogue scale [VAS] ≤ 3) in Taiwan population. This was a randomized, double-blind, placebo-controlled study. Forty-seven subjects were enrolled and randomly allocated to either the A+HA or the placebo groups. The subjects were required to drink a bottle contained 20 mL of A+HA or placebo daily throughout an 8-week study period. The efficacy was assessed by using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the 36-item Short Form Survey (SF-36). RESULTS: At Week 8, significant reductions from baseline in the WOMAC pain (-2.6 ±â€Š1.68, P < .0001), stiffness (-1.2 ±â€Š1.50, P = .007), physical function (-5.8 ±â€Š4.39, P < .0001), and total (-9.4 ±â€Š5.82, P < .0001) scores were observed in the A+HA group but not in the placebo group. Significant differences in the mean change of WOMAC scores from baseline at Week 8 between groups were detected (P < .01). At Week 8, the A+HA group also showed significant improvements in SF-36 physical functioning (2.7 ±â€Š3.10, P = .001) and bodily pain (0.7 ±â€Š1.50, P < .05) domains. Although the A+HA group had a higher increase in the SF-36 total score than the placebo group but the difference was not statistically significant (2.1 ±â€Š12.75 vs 0.3 ±â€Š19.66, P = .12). CONCLUSIONS: Oral administration of low molecular weight liquid HA appeared to be effective for knee OA patients with mild knee pain (VAS ≤ 3) in the relief of knee OA symptoms, particularly in pain and physical function.Clinical Trial Registration: NCT04352322.


Assuntos
Artralgia , Condroitina/administração & dosagem , Glucosamina/administração & dosagem , Ácido Hialurônico/administração & dosagem , Osteoartrite do Joelho , Administração Oral , Artralgia/diagnóstico , Artralgia/tratamento farmacológico , Artralgia/etiologia , Misturas Complexas/administração & dosagem , Suplementos Nutricionais , Método Duplo-Cego , Monitoramento de Medicamentos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/tratamento farmacológico , Osteoartrite do Joelho/fisiopatologia , Medição da Dor/métodos , Resultado do Tratamento , Viscossuplementos/administração & dosagem
10.
Med Clin North Am ; 105(1): 117-136, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33246514

RESUMO

Knee pain is present in up to 20% of the adult general population and can be significantly debilitating to patients. A thorough history and physical examination can help localize the source of inflammation or injury to further determine if imaging, physical therapy, specialty referral, or surgery is necessary. By following a systematic approach to evaluating knee pain, primary care physicians can make the correct diagnosis and formulate an appropriate therapeutic strategy for patients.


Assuntos
Assistência Ambulatorial , Artralgia/etiologia , Artralgia/terapia , Adulto , Idoso , Artralgia/classificação , Artralgia/diagnóstico , Tratamento Conservador , Diagnóstico Diferencial , Diagnóstico por Imagem , Terapia por Exercício , Feminino , Humanos , Masculino , Anamnese , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/terapia , Exame Físico , Perda de Peso , Adulto Jovem
11.
Medicine (Baltimore) ; 99(52): e23470, 2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33350730

RESUMO

ABSTRACT: To assess diagnostic criteria and currently used tools for the identification of central sensitization (CS) in patients with joint pain due to osteoarthritis (OA).Qualitative, cross-sectional and multicenter study based on a 2-round Delphi surveyPublic and private medical centers attending patients with joint pain.A total of 113 specialists in traumatology, physical medicine and rehabilitation, pain management, rheumatology, primary care physicians and geriatrics were enrolled in the study.Participants completed an ad-hoc 26-item questionnaire available from a microsite in Internet.The questionnaire was divided into 6 sections with general data on CS, impact of CS in patients with knee osteoarthritis (KOA), diagnostic criteria for CS, non-pharmacological and pharmacological treatment of CS and usefulness of the concept of CS in the integral management of patients with KOA. Consensus was defined as 75% agreement.Diagnostic criteria included pain of disproportionate intensity to the radiological joint lesion (agreement 86.7%), poor response to usual analgesics (85.8%), progression of pain outside the site of the lesion (76.1%) and concurrent anxiety and depression (76.1%). Based on the opinion of the specialists, about 61% of patients with KOA present moderate-to-severe pain, 50% of them show poor response to conventional analgesics, and 40% poor clinical-radiological correlation. Patients with KOA and CS showed higher functional disability and impairment of quality of life than those without CS (88.5%) and have a poor prognosis of medical, rehabilitation and surgical treatment (86.7%). Early diagnosis and treatment of CS may preserve function and quality of life during all steps of the disease (90.3%).The management of patients with osteoarthritis pain and CS requires the consideration of the intensity of pain related to the joint lesion, response to analgesics, progression of pain to other areas and concurrent anxiety and depression to establish an adequate therapeutic approach based on diagnostic criteria of CS.


Assuntos
Artralgia/diagnóstico , Artralgia/fisiopatologia , Sensibilização do Sistema Nervoso Central , Osteoartrite do Joelho/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/etiologia , Artralgia/etiologia , Estudos Transversais , Técnica Delfos , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Medição da Dor
12.
PLoS One ; 15(12): e0242710, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33362248

RESUMO

INTRODUCTION: The use of patient-reported outcomes (PROs) to systematically quantify adverse events (AE) will assist in the improvement of medical care and the QoL of patients living with HIV (PLWH). The aim of this study was to investigate the associations between self-reported side effects and other PROs, demographics and laboratory data, and further evaluate the Health Questionnaire (HQ) as a tool for following trends in patient-reported side effects over time in relation to trends in prescribed third agent in ART. MATERIALS AND METHODS: The Swedish National Registry InfCareHiv includes an annual self-reported nine-item HQwhich is used in patient-centered HIV care in all Swedish HIV units. In this study, the experience of side effects was addressed. We analyzed 9,476 HQs completed by 4,186 PLWH together with details about their prescribed ART and relevant biomarkers collected during 2011-2017. Data were analyzed using descriptive statistics, Pearson's correlation coefficient and mixed logistic regression. RESULTS: The cross-sectional analysis of the HQs showed that the frequency of reported side effects decreased from 32% (2011) to 15% (2017). During the same period, there was a shift in ART prescription from efavirenz (EFV) to dolutegravir (DTG) (positive correlation coefficient r = 0.94, p = 0.0016). Further, PLWH who reported being satisfied with their physical health (OR: 0.47, p = <0.001) or psychological health (OR: 0.70, p = 0.001) were less likely to report side effects than those less satisfied. CONCLUSIONS: Self-reported side effects were found to have a close relationship with the patient's ratings of their overall health situation and demonstrated a strong correlation with the sharp decline in use of EFV and rise in use of DTG, with reported side effects being halved. This study supports the feasibility of using the HQ as a tool for longitudinal follow up of trends in PROs.


Assuntos
Alquinos/efeitos adversos , Fármacos Anti-HIV/efeitos adversos , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Benzoxazinas/efeitos adversos , Ciclopropanos/efeitos adversos , Infecções por HIV/tratamento farmacológico , Compostos Heterocíclicos com 3 Anéis/efeitos adversos , Oxazinas/efeitos adversos , Piperazinas/efeitos adversos , Piridonas/efeitos adversos , Qualidade de Vida/psicologia , Sistema de Registros , Adulto , Alquinos/administração & dosagem , Fármacos Anti-HIV/administração & dosagem , Artralgia/induzido quimicamente , Artralgia/diagnóstico , Artralgia/fisiopatologia , Benzoxazinas/administração & dosagem , Estudos Transversais , Ciclopropanos/administração & dosagem , Disfunção Erétil/induzido quimicamente , Disfunção Erétil/diagnóstico , Disfunção Erétil/fisiopatologia , Feminino , HIV/efeitos dos fármacos , Infecções por HIV/fisiopatologia , Infecções por HIV/psicologia , Infecções por HIV/virologia , Compostos Heterocíclicos com 3 Anéis/administração & dosagem , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Náusea/induzido quimicamente , Náusea/diagnóstico , Náusea/fisiopatologia , Oxazinas/administração & dosagem , Medidas de Resultados Relatados pelo Paciente , Piperazinas/administração & dosagem , Piridonas/administração & dosagem , Suécia
13.
Av. odontoestomatol ; 36(4): 208-217, sept.-dic. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-198591

RESUMO

INTRODUCCIÓN: Para los trastornos temporomandibulares (TTM) el tratamiento de primera línea es el conservador, éste incluye a la terapia convencional, además se ha descrito el uso de la estimulación nerviosa eléctrica transcutánea (TENS). El objetivo de este estudio fue determinar la respuesta terapéutica del TENS como complemento a la terapia convencional comparado con pacientes que recibieron exclusivamente terapia convencional. MATERIAL Y MÉTODOS: Estudio retrospectivo caso-control en pacientes diagnosticados con TTM, tratados en la Clínica de Especialidades de la Escuela de Odontología de la Universidad de Valparaíso, entre los años 2009 y 2012. De los 231 pacientes, 63 cumplieron con los criterios de inclusión y fueron pareados en un grupo convencional y un grupo TENS. Se evaluó el dolor articular y muscular; aperturas mandibulares activa sin dolor, activa forzada y pasiva; y fuerza masticatoria. Se aplicaron test estadísticos de Kruskal-Wallis, Wilcoxon y Spearman. RESULTADOS: Para el grupo TENS, se encontraron respuestas significativas en dolor articular y muscular derecho e izquierdo, apertura mandibular activa sin dolor y fuerza masticatoria. Para el grupo convencional, se encontraron resultados similares a excepción de dolor articular derecho. También respuestas significativas para todas las variables que midieron dolor inmediatamente posterior a la aplicación de TENS. Finalmente se establecieron correlaciones entre la edad y las aperturas activa sin dolor, activa forzada y pasiva. DISCUSIÓN: La terapia convencional y la complementada con TENS demostraron similar respuesta terapéutica a largo plazo, sin embargo, la aplicación del TENS produce una respuesta inmediata que reduce el dolor en el corto plazo


INTRODUCTION: For temporomandibular disorders (TMD), conservative therapies, including conventional therapy, are the first line of treatment, and the use of transcutaneous electrical nerve stimulation (TENS) has also been reported. The aim of this study was to determine the therapeutic response to TENS as complement to conventional therapy compared with patients receiving conventional therapy exclusively. METHODOLOGY: A retrospective study was carried out with patients diagnosed with TMD, treated at the Clinic of Specialties of the Dental School of Universidad de Valparaíso, between 2009 and 2012. Of 231 patients, 63 met the inclusion criteria and were randomly allocated to a conventional therapy group (controls) and a coadjuvant TENS group (cases). Both were evaluated for pain in the temporomandibular joints (TMJ) and masseters, active opening without pain, forced active opening, passive opening, and occlusal force. Statistical analysis was performed with Kruskal-Wallis, Wilcoxon and Spearman tests. RESULTS: For TENS group, significant differences were found for pain in the right and left TMJ, pain in the right and left masseter, active opening without pain, and occlusal force. For the conventional group, the same results were obtained, except for pain in right TMJ. For the variables measured immediately after applying TENS, significant differences were found in all pain variables. Correlations were established with age, active opening without pain, forced active opening, and passive opening. DISCUSSION: Conventional therapy and TENS-complemented therapy showed good therapeutic response, concluding that TENS is a good complement to conventional therapy


Assuntos
Humanos , Masculino , Feminino , Adulto , Transtornos da Articulação Temporomandibular/terapia , Estimulação Elétrica Nervosa Transcutânea/métodos , Estudos de Casos e Controles , Estudos Retrospectivos , Artralgia/diagnóstico , Mialgia/diagnóstico , Força de Mordida
16.
J Vasc Interv Radiol ; 31(9): 1453-1458, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32868019

RESUMO

Ten patients with painful early-stage knee osteoarthritis underwent transcatheter arterial embolization of neoangiogenic branches from genicular arteries. At 12 months, 6 patients had responded to treatment according to study criteria. Median pain, function, and quality-of-life scores had improved by 15.4%, 21.3%, and 100%, respectively, for the 10 patients. Median 30-second chair stand test and 6-minute walk test scores had improved by 43% and 26%, respectively. No major adverse events occurred. Improvements following transcatheter arterial embolization provide evidence that embolization might be an effective treatment technique for people with early-stage knee osteoarthritis, although more rigorous evaluation is required.


Assuntos
Artralgia/terapia , Embolização Terapêutica , Articulação do Joelho/irrigação sanguínea , Neovascularização Patológica , Osteoartrite do Joelho/terapia , Idoso , Artralgia/diagnóstico , Artralgia/fisiopatologia , Fenômenos Biomecânicos , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/fisiopatologia , Projetos Piloto , Estudos Prospectivos , Qualidade de Vida , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento
17.
Zhonghua Wai Ke Za Zhi ; 58(8): 631-635, 2020 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-32727196

RESUMO

Objective: To examine the short-term outcomes of modified load-sharing rip-stop repair (mLSRS) and suture-bridge repair (SB) for large rotator cuff tear. Methods: The clinical data of patients who underwent shoulder arthroscopy for large rotator cuff repair at Department of Orthopedic, China Academy of Chinese Medical Sciences Wang Jing Hospital from January 2017 to December 2018 were collected. Totally 111 patients (39 in mLSRS group and 72 in SB group) were included in the study. There were 45 males and 66 females, aged (58.0±6.9)years (range: 40 to 72 years).A total of 39 pairs of patients were successfully matched by propensity score matching. The pain of shoulder joint was assessed by visual analogy score (VAS) , the shoulder function was assessed by Constant-Murley score, the abduction strength of bilateral shoulder joint was assessed by 90˚ force assessment method of upper limb on the plane of scapula, and the healing of rotator cuff on the operative side was assessed by sugaya ultrasonic classification standard. The difference of short-term outcome between the two groups were compared using t test, χ(2) test, Mann-Whitney U test, repeated measures design anova and multivariate analysis of variance. Results: At the 4th week after surgery, the VAS of mLSRS group was significantly lower than SB group(1 (2) vs. 2 (2) , F=5.32, P=0.02). One year after surgery, Constant-Murley score of two groups were significantly higher than those before surgery, but there was no significant difference between two groups(89.1±5.7 vs. 87.6±7.3, t=1.00, P=0.32). Abductor strength of affected limbs were lower than that of the opposite side, but there were no statistically significant differences between two groups(4.28±1.61 vs. 4.54±1.64, t=-0.70, P=0.49). According to the Sugaya classification, 32 cases in mLSRS group were healed while 7 cases were not healed,30 cases in SB group were healed while 9 cases were not healed(χ(2)=0.32, P=0.58). Conclusion: The use of mLSRS fixation construct on large rotator cuff tear can reduce pain and the short-term outcome is reliable.


Assuntos
Lesões do Manguito Rotador/cirurgia , Técnicas de Sutura , Adulto , Idoso , Artralgia/diagnóstico , Artralgia/etiologia , Artralgia/cirurgia , Artroscopia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Amplitude de Movimento Articular , Manguito Rotador/cirurgia , Articulação do Ombro/cirurgia , Resultado do Tratamento
18.
Cochrane Database Syst Rev ; 7: CD013665, 2020 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-32633856

RESUMO

BACKGROUND: Some people with SARS-CoV-2 infection remain asymptomatic, whilst in others the infection can cause mild to moderate COVID-19 disease and COVID-19 pneumonia, leading some patients to require intensive care support and, in some cases, to death, especially in older adults. Symptoms such as fever or cough, and signs such as oxygen saturation or lung auscultation findings, are the first and most readily available diagnostic information. Such information could be used to either rule out COVID-19 disease, or select patients for further diagnostic testing. OBJECTIVES: To assess the diagnostic accuracy of signs and symptoms to determine if a person presenting in primary care or to hospital outpatient settings, such as the emergency department or dedicated COVID-19 clinics, has COVID-19 disease or COVID-19 pneumonia. SEARCH METHODS: On 27 April 2020, we undertook electronic searches in the Cochrane COVID-19 Study Register and the University of Bern living search database, which is updated daily with published articles from PubMed and Embase and with preprints from medRxiv and bioRxiv. In addition, we checked repositories of COVID-19 publications. We did not apply any language restrictions. SELECTION CRITERIA: Studies were eligible if they included patients with suspected COVID-19 disease, or if they recruited known cases with COVID-19 disease and controls without COVID-19. Studies were eligible when they recruited patients presenting to primary care or hospital outpatient settings. Studies including patients who contracted SARS-CoV-2 infection while admitted to hospital were not eligible. The minimum eligible sample size of studies was 10 participants. All signs and symptoms were eligible for this review, including individual signs and symptoms or combinations. We accepted a range of reference standards including reverse transcription polymerase chain reaction (RT-PCR), clinical expertise, imaging, serology tests and World Health Organization (WHO) or other definitions of COVID-19. DATA COLLECTION AND ANALYSIS: Pairs of review authors independently selected all studies, at both title and abstract stage and full-text stage. They resolved any disagreements by discussion with a third review author. Two review authors independently extracted data and resolved disagreements by discussion with a third review author. Two review authors independently assessed risk of bias using the QUADAS-2 checklist. Analyses were descriptive, presenting sensitivity and specificity in paired forest plots, in ROC (receiver operating characteristic) space and in dumbbell plots. We did not attempt meta-analysis due to the small number of studies, heterogeneity across studies and the high risk of bias. MAIN RESULTS: We identified 16 studies including 7706 participants in total. Prevalence of COVID-19 disease varied from 5% to 38% with a median of 17%. There were no studies from primary care settings, although we did find seven studies in outpatient clinics (2172 participants), and four studies in the emergency department (1401 participants). We found data on 27 signs and symptoms, which fall into four different categories: systemic, respiratory, gastrointestinal and cardiovascular. No studies assessed combinations of different signs and symptoms and results were highly variable across studies. Most had very low sensitivity and high specificity; only six symptoms had a sensitivity of at least 50% in at least one study: cough, sore throat, fever, myalgia or arthralgia, fatigue, and headache. Of these, fever, myalgia or arthralgia, fatigue, and headache could be considered red flags (defined as having a positive likelihood ratio of at least 5) for COVID-19 as their specificity was above 90%, meaning that they substantially increase the likelihood of COVID-19 disease when present. Seven studies carried a high risk of bias for selection of participants because inclusion in the studies depended on the applicable testing and referral protocols, which included many of the signs and symptoms under study in this review. Five studies only included participants with pneumonia on imaging, suggesting that this is a highly selected population. In an additional four studies, we were unable to assess the risk for selection bias. These factors make it very difficult to determine the diagnostic properties of these signs and symptoms from the included studies. We also had concerns about the applicability of these results, since most studies included participants who were already admitted to hospital or presenting to hospital settings. This makes these findings less applicable to people presenting to primary care, who may have less severe illness and a lower prevalence of COVID-19 disease. None of the studies included any data on children, and only one focused specifically on older adults. We hope that future updates of this review will be able to provide more information about the diagnostic properties of signs and symptoms in different settings and age groups. AUTHORS' CONCLUSIONS: The individual signs and symptoms included in this review appear to have very poor diagnostic properties, although this should be interpreted in the context of selection bias and heterogeneity between studies. Based on currently available data, neither absence nor presence of signs or symptoms are accurate enough to rule in or rule out disease. Prospective studies in an unselected population presenting to primary care or hospital outpatient settings, examining combinations of signs and symptoms to evaluate the syndromic presentation of COVID-19 disease, are urgently needed. Results from such studies could inform subsequent management decisions such as self-isolation or selecting patients for further diagnostic testing. We also need data on potentially more specific symptoms such as loss of sense of smell. Studies in older adults are especially important.


Assuntos
Assistência Ambulatorial , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Atenção Primária à Saúde , Avaliação de Sintomas , Artralgia/diagnóstico , Artralgia/etiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Fadiga/diagnóstico , Fadiga/etiologia , Febre/diagnóstico , Febre/etiologia , Cefaleia/diagnóstico , Humanos , Mialgia/diagnóstico , Mialgia/etiologia , Ambulatório Hospitalar/estatística & dados numéricos , Pandemias , Exame Físico , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Viés de Seleção , Avaliação de Sintomas/classificação , Avaliação de Sintomas/estatística & dados numéricos
19.
Medicine (Baltimore) ; 99(28): e21131, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664142

RESUMO

INTRODUCTION: Tumor necrosis factor alpha (TNF-α) mediated inflammation has been implicated, in knee osteoarthritis, despite being a predominantly degenerative condition. PATIENT CONCERNS: A 56-year old female, a case of left knee pain not responding to conventional conservative strategies. DIAGNOSIS: A diagnosis of primary osteoarthritis of the left knee, grade 3 osteoarthritis as per the Kellgren-Lawrence Scale was established. INTERVENTIONS: She was administered an intra-articular injection of 10 mg of Adalimumab, a commonly used anti-TNF agent. OUTCOMES: The patient was evaluated at baseline, 1 month, 3 months, and at 6 months. There was a marked improvement in pain intensity (visual analog scale) and quality of life, despite no objective change on the parameters seen on ultrasound of the knee. CONCLUSION: Injection of adalimumab via the intra-articular route into the knee joint in primary osteoarthritis yields promising results.


Assuntos
Adalimumab/administração & dosagem , Artralgia/diagnóstico , Osteoartrite do Joelho/tratamento farmacológico , Medição da Dor/métodos , Antirreumáticos/administração & dosagem , Artralgia/tratamento farmacológico , Artralgia/etiologia , Feminino , Humanos , Injeções Intra-Articulares , Articulação do Joelho , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Fator de Necrose Tumoral alfa/antagonistas & inibidores
20.
Pain Physician ; 23(4): 429-438, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32709178

RESUMO

BACKGROUND: Ehlers-Danlos syndrome (EDS) is a multifaceted disease that can present with a variety of types of pain. Unfortunately, both the mechanisms and treatments for pain are poorly understood. The proposed treatments for the various musculoskeletal pain syndromes in EDS have had variable success, and it becomes much more imperative to better define and evaluate the current treatment modalities in treating this debilitating disease. OBJECTIVES: The purpose of this study was to investigate the currently available treatment modalities for patients with EDS and their efficacies in pain and symptom relief. STUDY DESIGN: Retrospective cohort study. SETTING: Institutional physical medicine and rehabilitation primary care clinic. METHODS: All patients were seen between January 2015 and April 2019, in which 98 patients with EDS were identified through retrospective chart review. Institutional review board approval was obtained, and all patients provided written consent to be included in the study. We reviewed various treatment modalities, including complimentary/alternative treatments, opioids/opioid-like medications, nonsteroidal antiinflammatory drugs, physical therapy, occupational therapy, muscle relaxants, neuropathic modulators, steroids, surgery/procedures, and acetaminophen. Treatment methods were extracted from individual patient charts, and efficacy was grouped into 3 categories: improvement, no effect, or worsened symptoms. RESULTS: The most common treatments used were complimentary/alternative treatments (n = 88). Occupational therapy and bracing were the most effective options with 70% of patients reporting improvement. Neuropathic modulators were the least well tolerated with 47% of patients reporting adverse effects. LIMITATIONS: Men were a small percentage of the study. Patients were not randomized, and pain score reporting was subjective. Patient data were extracted from a single practice setting. Timing and symptom onset were not measured. CONCLUSIONS: There is a relative paucity of published literature regarding the various treatment methods for EDS. Although our study is able to identify positive and negative trends with certain modalities, it is vital to understand that EDS is not a uniform diagnosis among patients, and that a combination of several different treatments usually is needed for optimal symptom control. Further research and investigation are necessary to develop a comprehensive treatment database for this complex condition. KEY WORDS: Ehlers-Danlos syndrome, pain, hypermobility, arthralgia, subluxation, genetic, physical therapy, interventional pain.


Assuntos
Síndrome de Ehlers-Danlos/diagnóstico , Síndrome de Ehlers-Danlos/terapia , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/terapia , Adolescente , Adulto , Idoso , Analgésicos Opioides/administração & dosagem , Anti-Inflamatórios não Esteroides/administração & dosagem , Artralgia/diagnóstico , Artralgia/terapia , Estudos de Coortes , Terapias Complementares/métodos , Terapias Complementares/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Relaxantes Musculares Centrais/administração & dosagem , Modalidades de Fisioterapia/tendências , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
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