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1.
BMC Health Serv Res ; 21(1): 901, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34470636

RESUMO

BACKGROUND: Advance Care Planning (ACP) has emerged to improve end-of-life processes and experiences. However, the available evidence presents the gloomy picture of increasing number of older people living with chronic diseases and the mismatch between their preferences for and the actual place of death. The study aimed to investigate the efficacy of normalisation of an Advance Care Planning (NACP) service delivered by specially trained Registered Nurses (RNs) in hospital and community settings. METHODS: A quasi-experimental study was conducted involving 16 sites (eight hospital and eight community sites) in Australia. Patients who were aged ≥18 years, who had at least one of nine chronic conditions, and who did not have an Advance Care Directive (ACD) were offered the NACP service. ACP was normalised as part of routine service on admission. The intervention, NACP, was a series of facilitated conversations about the components of ACP. The primary outcomes which included the completion of ACDs, and/or appointment of an Enduring Guardian (EG), were assessed in both intervention and control sites at pre and post intervention stages. Numbers of patients who completed an ACD or appointed an EG were described by count (percentage). ACD completion was compared between intervention and control sites using a logistic mixed effects regression model. The model includes fixed effects for treatment group, period, and their interaction, as well as random site level intercepts. Secondary model included potentially confounding variables as covariates, including age, sex and chronic diseases. RESULTS: The prevalence of legally binding ACDs in intervention sites has increased from five to 85 (from 0.85% in pre to 17.6% in post), whereas it has slightly decreased from five to 2 (from 1.2% in pre and to 0.49% in post) in control sites (the difference in these changes being statistically significant p < 0.001). ACD completion rate was 3.6% (n = 4) in LHD1 and 1.2% (n = 3) in LHD2 in hospital whereas it was 53% (n = 26) in LHD1 and 80% (n = 52) in LHD2 in community. CONCLUSIONS: The study demonstrated that NACP service delivered by ACP RNs was effective in increasing completion of ACDs (interaction odds ratio = 50) and was more effective in community than hospital settings. Involvement of various healthcare professionals are warranted to ensure concordance of care. TRIAL REGISTRATION: The study was retrospectively registered with the Australian New Zealand Clinical Trials Registry (Trial ID: ACTRN12618001627246 ) on 03/10/2018. The URL of the trial registry record http://www.anzctr.org.au/trial/MyTrial.aspx.


Assuntos
Planejamento Antecipado de Cuidados , Adolescente , Adulto , Diretivas Antecipadas , Idoso , Austrália/epidemiologia , Doença Crônica , Hospitais , Humanos , Ensaios Clínicos Controlados não Aleatórios como Assunto
2.
Zhonghua Yi Xue Za Zhi ; 101(34): 2710-2716, 2021 Sep 14.
Artigo em Chinês | MEDLINE | ID: mdl-34510878

RESUMO

Objective: To analyze the clinical characteristics of chronic total coronary occlusion (CTO) combined with bifurcation lesions and the features of coronary intervention and perioperative complications. Methods: This study adopted retrospective cross-sectional research methods and included 673 patients who underwent interventional therapy for chronic total occlusion in Beijing Anzhen Hospital. According to whether there were side branches (diameter ≥2 mm) within 5 mm before and after the CTO occlusion segment, patients were divided into bifurcation group (337 cases) and non-bifurcation group (336 cases). The measurement data did not conform to the normal distribution and were represented as M (Q1, Q3). The clinical risk factors, coronary angiography characteristics, interventional treatment strategies and perioperative complications were compared between the two groups. Results: The patients in the bifurcation group were 60 (51, 65) years old, and 86.6% (292 cases) were male; the patients in the non-bifurcation group were 60 (52, 66) years old, and 83.0% (279 cases) were male.Coronary artery disease in all patients was mainly multivessel disease, of which three-vessel disease accounted for 59.9% (403 cases) and double-vessel disease accounted for 25.4% (171 cases).The target vessel in the bifurcation group was predominantly left anterior descending artery (62.3%, 210 cases), and the target vessel in the non-bifurcation group was more common in the right coronary artery (56%, 188 cases). The target vessel diameter was larger in the bifurcation group (2.91(2.71, 3.24) mm vs 2.80(2.55, 3.13) mm, P<0.001). Most patients used the antegrade technique (88%, 592 cases), and the use of antegrade technique in the bifurcation group (91.9%, 307 cases) was higher than that in the non-bifurcation group (84.8%, 285 cases) (P=0.012). After CTO-PCI, 72.8% (490 cases) of patients achieved successful angiography. A total of 73 patients (10.8%) had perioperative complications, and there was no statistical difference between the two groups. However, the incidence of perioperative myocardial infarction was higher in the bifurcation group (5.9%, 20 cases) than non-bifurcation group (2.7%, 9 cases) (P=0.038). Conclusions: CTO complicated with bifurcation lesions are very common in clinical practice. Most patients with CTO have multiple coronary artery disease at the same time. The target vessel is more common in the left anterior descending artery, and the diameter of the vessel is larger. It is more common to use antergrade technique, accompanied by more perioperative myocardial infarctions.


Assuntos
Oclusão Coronária , Intervenção Coronária Percutânea , Idoso , Doença Crônica , Angiografia Coronária , Estudos Transversais , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
4.
BMC Public Health ; 21(1): 1611, 2021 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479522

RESUMO

BACKGROUND: Neighborhood social cohesion (NSC) is the network of relationships as well as the shared values and norms of residents in a neighborhood. Higher NSC has been associated with improved cardiovascular health, largely among Whites but not African Americans. In a bi-racial cohort, we aimed to study the association between NSC and chronic disease awareness and engagement in healthy self-management behaviors, two potential mechanisms by which NSC could impact cardiovascular health outcomes. METHODS: Using the Healthy Aging in Neighborhoods of Diversity Across the Lifespan Study (HANDLS), we cross-sectionally examined the association between NSC and awareness of three chronic conditions (diabetes, chronic kidney disease (CKD), and hypertension) and engagement in healthy self-management behaviors including physical activity, healthy eating, and cigarette avoidance. RESULTS: Study participants (n = 2082) had a mean age of 56.5 years; 38.7% were White and 61.4% African American. Of the participants, 26% had diabetes, 70% had hypertension and 20.2% had CKD. Mean NSC was 3.3 (SD = 0.80) on a scale of 1 (lowest score) to 5 (highest score). There was no significant association between NSC and any chronic disease awareness, overall or by race. However, each higher point in mean NSC score was associated with less cigarette use and healthier eating scores, among Whites (adjusted odds ratio [aOR], 95% confidence interval [CI]: =0.76, 0.61-0.94; beta coefficient [ßc]:, 95% CI: 1.75; 0.55-2.97, respectively) but not African Americans (aOR = 0.95, 0.79-1.13; ßc: 0.46, - 0.48-1.39, respectively; Pinteraction = 0.08 and 0.06). Among both Whites and African Americans, higher NSC scores were associated with increases in self-reported physical activity (ßc: 0.12; 0.08-0.16; Pinteraction = 0.40). CONCLUSIONS: Community engagement and neighborhood social cohesion may be important targets for promotion of healthy behaviors and cardiovascular disease prevention. More research is needed to understand the different associations of NSC and healthy behaviors by race.


Assuntos
Comportamento Cooperativo , Características de Residência , Afro-Americanos , Doença Crônica , Comportamentos Relacionados com a Saúde , Humanos , Pessoa de Meia-Idade
5.
Rev Assoc Med Bras (1992) ; 67(3): 366-372, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34468599

RESUMO

OBJECTIVE: To analyze the prevalence and factors associated with professional recommendation and leisure-time physical activity (LTPA) in Brazilian individuals diagnosed with hypertension (HBP), diabetes, and/or hypercholesterolemia. METHODS: This is a cross-sectional population-based study with a representative sample of the Brazilian population (aged ≥20 years) in 2013, with self-reported HBP (n=11.098), diabetes (n=3.176), and/or hypercholesterolemia (n=7.252). Prevalence and gross odds ratios were estimated and adjusted for both outcomes. RESULTS: Professional recommendation and LTPA were more prevalent in individuals who received recommendation and presented with hypercholesterolemia (85.9 and 23.4%, respectively). Adjusted analysis showed an association in people 40 to 59 years of age and public programs in most diseases. Higher educational level was associated with receiving recommendations in all non-communicable diseases (NCDs). LTPA was associated in people 40 to 59 years of age for HBP and diabetes and in all investigated NCDs, higher educational level, positive perception of health, and a favorable environment in those who received recommendation. CONCLUSIONS: Education presented the greatest magnitude in the associations, clearly showing the need for equitable methods to increase recommendation and LTPA levels for the most vulnerable population. Further studies analyzing other variables and NCD are needed, corroborating the Ministry of Health.


Assuntos
Exercício Físico , Hipertensão , Brasil/epidemiologia , Doença Crônica , Estudos Transversais , Humanos , Hipertensão/epidemiologia , Atividades de Lazer
6.
Rev Esc Enferm USP ; 55: e20200131, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34495207

RESUMO

OBJECTIVE: To describe the role of nurses in the integration of care for people with chronic noncommunicable diseases. METHOD: This was an integrated single-case study conducted with care coordinators and nurses, purposefully selected, with interviews, documentary analysis and computerized files as sources of evidence. Categorical analysis was used based on data organization using MAXQDA® software, version 2018. RESULTS: Thirty-four professionals participated. Most of the professionals who held coordination positions were nurses. The categories clinical team integration and care integration and their subcategories increased understanding of the roles of nurses. CONCLUSION: The role of nurses in integrating care for people with chronic noncommunicable diseases was mainly focused on coordination of care, which occurred because of the different roles that they play and that give them autonomy to make decisions and place them in the front line to contribute to situations that required assertive attitudes, such as directing users within the care network.


Assuntos
Doenças não Transmissíveis , Enfermeiras e Enfermeiros , Doença Crônica , Humanos , Doenças não Transmissíveis/terapia , Papel do Profissional de Enfermagem
7.
Adv Exp Med Biol ; 1325: 321-339, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34495543

RESUMO

WHO defines health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." We coined and defined suboptimal health status (SHS) as a subclinical, reversible stage of the pre-chronic disease. SHS is a physical state between health and disease, characterized by health complaints, general weakness, chronic fatigue, and low energy levels. We have developed an instrument to measure SHS, Suboptimal Health Status Questionnaire-25 (SHSQ-25), a self-reported survey assessing five health components that has been validated in various ethnical populations. Our studies suggest that SHS is associated with the major components of cardiovascular health and the early onset of metabolic diseases. Besides subjective measure of health (SHS), glycans are conceived as objective biomarkers of SHS. Glycans are complex and branching carbohydrate moieties attached to proteins, participating in inflammatory regulation and chronic disease pathogenesis. We have been investigating the role of glycans and SHS in multiple cardiometabolic diseases in different ethnical populations (African, Chinese, and Caucasian). Here we present case studies to prove that a combination of subjective health measure (SHS) with objective health measure (glycans) represents a window of opportunity to halt or reverse the progression of chronic diseases.


Assuntos
Nível de Saúde , Biomarcadores , Doença Crônica , Glicosilação , Humanos , Inquéritos e Questionários
8.
Tijdschr Gerontol Geriatr ; 52(2)2021 Jun 09.
Artigo em Holandês | MEDLINE | ID: mdl-34498440

RESUMO

The prevalence of multimorbidity increases with age, with over 70% of people aged 75 years and over having three or more chronic conditions, often combined with frailty. In current medical practice, evidence-based medicine with evidence-based guidelines forms the basis for treatment. The aim of this study is to determine the practical applicability of the current medical specialist guidelines for the treatment of the heterogeneous group of older patients. All guidelines from the Dutch guidelines database were examined. Twelve guidelines identified as elderly-specific were compared with the recommendations from the 'methodology for the development of guidelines tailored to the elderly'. In 117 guidelines (54%) general terms such as 'older' or 'elderly' were found. An age limit was mentioned in 26 guidelines (12%). The term 'frailty' was mentioned in 38 guidelines (18%), the term 'comorbidity' in 107 (50%) and cognitive problems in eight (4%). Five age-specific guidelines distinguished frail from non-frail older people. Three guidelines discussed relevant outcome measures for the elderly. The results show that the practical applicability of current guidelines is not optimal for the various groups of older people. In our opinion, the improvement of the guidelines preferably by implementation of the Dutch methodology for senior-proof guidelines is a necessary first step in making the current second-line evidence-based guidelines in the Netherlands usable for the growing group of frail and multimorbid elderly.


Assuntos
Fragilidade , Idoso , Doença Crônica , Comorbidade , Idoso Fragilizado , Fragilidade/diagnóstico , Humanos , Países Baixos , Prevalência
9.
Artigo em Russo | MEDLINE | ID: mdl-34481443

RESUMO

Chronic migraine (CM), a condition where patients experience over 15 days of headache per month, was identified as a separate disease in the International Classification of Headache Disorders 3-beta version. Onabotulinumtoxin type A was approved for the treatment of CM in 2010 after the completion of the extensive PREEMPT (Phase III Research Evaluating Migraine Prophylaxis Therapy) clinical program. The efficacy of onabotulinumtoxin type A was demonstrated in numerous studies in CM and medication-overuse headache. The paper focuses on the PREEMPT injection paradigm and provides guidance for successful and safe treatment of CM.


Assuntos
Toxinas Botulínicas Tipo A , Transtornos da Cefaleia Secundários , Transtornos de Enxaqueca , Doença Crônica , Humanos , Transtornos de Enxaqueca/tratamento farmacológico , Compostos Orgânicos , Resultado do Tratamento
10.
Urologiia ; (4): 68-72, 2021 Sep.
Artigo em Russo | MEDLINE | ID: mdl-34486277

RESUMO

INTRODUCTION: Chronic recurrent bacterial prostatitis (CRPD) is an urgent problem of modern urology and andrology. OBJECTIVE: To study the immunological features of the secretion of the prostate by electron microscopy in patients with chronic recurrent bacterial prostatitis. MATERIALS AND METHODS: The analysis of the morphometric study of neutrophils in the secretion of the prostate was carried out in 90 patients with chronic bacterial prostatitis, who were divided into two groups. Group I (study) (n=51) with chronic recurrent bacterial prostatitis (CRBP) and group II (control) (n=39) with chronic primary diagnosed bacterial prostatitis (CPDBP). RESULTS: At electron microscopy of ALE in most patients with CRBP of the group, the cytological picture of ALE was represented by inactive neutrophils with pathology of phagocytosis. The cells are of the correct rounded shape, without pseudopodia, with light cytoplasm. The cytological picture of ALE in CPDBP is characterized by the absence of impaired local immunity. The normal process of phagocytosis is recorded, where many pseudopodia of the segmented neutrophil completely complete the process of opsonization of microorganisms in the area of the inflammatory process. CONCLUSIONS: In patients with CRBP, in 100% of cases, dysfunction of immunocompetent prostate cells was noted, which is the basis for the appointment of immunoactive therapy for CRBP.


Assuntos
Prostatite , Doença Crônica , Eletrônica , Humanos , Masculino , Microscopia Eletrônica
11.
Urologiia ; (4): 138-144, 2021 Sep.
Artigo em Russo | MEDLINE | ID: mdl-34486287

RESUMO

A review of the literature on the urgent problem of urology, which is therapy of chronic prostatitis (CP) is presented. Despite numerous studies dedicated to the prevention and treatment of CP, it has not yet been possible to reduce the CP incidence. Therapeutic approaches aimed at improving the quality of life are not always effective due to the lack of a clear understanding of the etiology and pathogenesis of the disease. Leading Russian urologists recommend introducing into the complex therapy of CP a domestic drug from the cytomedin, namely Vitaprost, which causes a significant decrease in the severity of trophic disorders, inflammatory and congestive processes, improves microcirculation in the prostate, stimulates cellular and humoral immunity, all of which increase the effectiveness of CP therapy.


Assuntos
Prostatite , Urologia , Doença Crônica , Humanos , Masculino , Prostatite/tratamento farmacológico , Qualidade de Vida , Federação Russa
12.
BMC Geriatr ; 21(1): 478, 2021 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-34481465

RESUMO

BACKGROUND: Regular physical activity (PA) is potentially beneficial for age-related cognitive decline. Although moderate-to-vigorous physical activity (MVPA) is mostly advised, older adults with chronic illnesses might benefit more from light physical activity (LPA), as they suffer from mobility problems, pain, and fatigue, limiting high-intensity PA. Therefore, the longitudinal association between change in LPA and MVPA and the change in cognitive functioning (CF) is investigated in older adults with chronic illnesses. METHODS: In total 432 older adults (mean age 73.7 [±6.1] years; 46.8% female) with at least one chronic illness participated in this longitudinal observational study. Longitudinal associations between accelerometer-assessed change in PA (LPA and MVPA) and change in CF, measured with an objective validated neuropsychological test battery, were tested with multivariate linear regressions. RESULTS: An increase in LPA between baseline and 6 months follow-up was significantly associated with improved short-term verbal memory and inhibition over the first 6 months. In addition, the change score in LPA over the first 6 months was predictive for the change score in short-term verbal memory over 12 months. Furthermore, an increase in MVPA between baseline and 6 months follow-up was significantly associated with a decrease in longer-term verbal memory scores over the same six-month period. CONCLUSIONS: For older adults with chronic illnesses who may experience difficulties in being sufficiently active, an increase in LPA is probably more achievable than an increase in MVPA. In addition, an increase in LPA enhances CF more than an increase in MVPA does. TRIAL REGISTRATION: Netherlands Trial Register NL6005 ; Date of Registration 21-03-2017.


Assuntos
Acelerometria , Exercício Físico , Idoso , Doença Crônica , Cognição , Feminino , Humanos , Estudos Longitudinais , Masculino
13.
BMC Psychiatry ; 21(1): 436, 2021 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488696

RESUMO

BACKGROUND: Chronic diseases have a high incidence in China and may cause pain and depression. However, the association of chronic diseases with pain and the incidence of depression has not been comprehensively investigated. METHODS: The study population was obtained from the 2015 China Health and Retirement Longitudinal Study (CHARLS). The cross-sectional data from15,213 persons were included. CHARLS provides nationally representative data from21,097 individuals aged 45 years and older in approximately 150 districts and 450 villages. The main outcome was the incidence of depression. The main independent variable was chronic disease (no chronic disease, one chronic disease, and two or more chronic diseases). The mediators were the degree of pain (no pain, mild pain, and moderate to severe pain) and whether measures were taken to relieve pain (measures taken and no measures taken). We performed chi-square and binary logistic regression analyses of the associations of chronic disease with pain and the incidence of depression. The mediation model was examined using the Sobel test. RESULTS: Patients with more chronic diseases had more severe pain (OR = 3.697, P < 0.001, CI = 2.919-4.681) and were more likely to develop depression (OR = 2.777, P < 0.001, CI = 2.497-3.090). The degree of pain partially mediated the interaction between chronic disease and depression in this study (t = 7.989, P < 0.001). The incidence of depression was high in people who were female, less educated, unmarried, living in rural areas, and working. CONCLUSIONS: The degree of pain had a partial mediating effect on chronic disease and depression. Pain relief measures should be considered when treating patients with depression.


Assuntos
Dor Crônica , Depressão , China/epidemiologia , Doença Crônica , Dor Crônica/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Dor
14.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 43(4): 531-535, 2021 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-34494522

RESUMO

Objective To explore the factors related to tympanic membrane perforation in children with acute suppurative otitis media,and to provide reference for clinical practice. Methods We reviewed the clinical data of 1274 children with acute suppurative otitis media from February 2017 to May 2020,and analyzed the factors related to tympanic membrane perforation. Results Tympanic membrane perforation occurred in 67 out of the 1274 children with acute suppurative otitis media,with the incidence of 5.27%.The univariate analysis showed that 11 factors including the duration of onset(t=2.381,P=0.017),upper respiratory tract infection(χ2=12.228,P=0.000),pulmonary infection(χ2=5.242, P=0.022),chronic sinusitis(χ2=12.715,P=0.000),adenoid hypertrophy(χ2=4.783,P=0.029),tympanic empyema(χ2=16.020,P=0.000),the duration of using antibiotics(t=-2.277,P=0.025),combined use of antibiotics(χ2=5.587,P=0.018),the time from onset to selection of antibiotics according to drug sensitivity(t=3.716,P=0.000),procalcitonin(t=2.599,P=0.009),and white blood cell count in peripheral blood(t=2.196,P=0.031)were related to tympanic membrane perforation in children with acute suppurative otitis media.The multivariate logistic analysis showed that the duration of onset(OR=4.854,95% CI=2.675-8.806,P=0.000),upper respiratory tract infection(OR=6.506,95% CI=3.213-13.171,P=0.000),chronic sinusitis(OR=7.866,95% CI=3.780-16.370,P=0.000),tympanic empyema(OR=2.625,95% CI=1.442-4.777,P=0.002),and time from onset to selection of antibiotics according to drug sensitivity(OR=5.107,95% CI=2.129-12.248,P=0.000)were independent risk factors for tympanic membrane perforation in children with acute suppurative otitis media. Conclusion The incidence of tympanic membrane perforation in children with acute suppurative otitis media can be reduced by early treatment,keeping the Eustachian tube unobstructed,draining the tympanic cavity,preventing chronic sinusitis and upper respiratory tract infection,early drug sensitivity test,and selection of antibiotics based on the test results.


Assuntos
Otite Média Supurativa , Perfuração da Membrana Timpânica , Criança , Doença Crônica , Humanos , Otite Média Supurativa/complicações , Pró-Calcitonina , Fatores de Risco , Perfuração da Membrana Timpânica/etiologia
15.
Trials ; 22(1): 606, 2021 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-34496924

RESUMO

BACKGROUND: Endoscopic sinus surgery (ESS) has been used for decades to treat recurrent acute rhinosinusitis episodes (RARS) in adults. RARS results in infectious symptoms, antibiotic courses, sick leaves, and impaired quality of life. Theoretically, the ESS procedure, through improving the drainage of the paranasal sinuses, decreases the symptoms and enhances the quality of life of the RARS patients. Whether this is true has not been reported in a randomized trial yet. METHODS: We conduct a single-center, non-blinded, randomized, 6-month, parallel group superiority clinical study including 80 adult participants referred to surgical treatment for RARS. The participants will either have ESS or conservative medical treatment (control group). The primary outcome will be the difference between the mean disease-specific Sinonasal Outcome Test 22 (quality of life questionnaire) change scores (from baseline to 6 months) of ESS and control group. DISCUSSION: This study will add significant new information to the effect and harms of ESS procedure in the treatment of adults with RARS. TRIAL REGISTRATION: ClinicalTrials.gov NCT04241016 . Registered on 17 January 2020.


Assuntos
Seios Paranasais , Rinite , Sinusite , Adulto , Doença Crônica , Endoscopia/efeitos adversos , Humanos , Seios Paranasais/diagnóstico por imagem , Seios Paranasais/cirurgia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Rinite/diagnóstico , Rinite/cirurgia , Sinusite/diagnóstico por imagem , Sinusite/cirurgia , Resultado do Tratamento
16.
Lakartidningen ; 1182021 Aug 23.
Artigo em Sueco | MEDLINE | ID: mdl-34498243

RESUMO

The PAH and CTEPH care in Sweden is since 2007 structured in collaboration with the Swedish Society of Pulmonary Hypertension (SveFPH) and centralized to pulmonary hypertension (PH) centers at the university hospitals. At biannual SveFPH meetings, ideas are exchanged to spread new knowledge on diagnostics and treatment in Sweden. The PAH-CTEPH centers are to be further stimulated to provide individual equal and equivalent care within multidisciplinary PAH-CTEPH teams in Sweden, as summarized in the document "Nationell samsyn kring PAH och CTEPH specialistcenter och mottagningar", prepared in collaboration between SveFPH and the Swedish PAH patient association, for initiation during the spring of 2021.


Assuntos
Hipertensão Pulmonar , Embolia Pulmonar , Doença Crônica , Consenso , Humanos , Hipertensão Pulmonar/terapia , Suécia
17.
Vestn Otorinolaringol ; 86(4): 59-66, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34499450

RESUMO

Cystic fibrosis (cystic fibrosis) is an important medical and social problem. The main clinical manifestations that determine the prognosis and outcome of this disease are changes in the respiratory and digestive systems. In recent years, there has been an understanding of the importance of assessing pathological changes in the nasal cavity and paranasal sinuses in patients with cystic fibrosis. RESEARCH OBJECTIVES: Assess the efficacy of topical antibacterial therapy in adult cystic fibrosis patients after surgery on nasal cavity structures and paranasal sinuses. MATERIAL AND METHODS: In the clinic for ear, nose and throat diseases at Sechenov University, 46 adult patients with cystic fibrosis and chronic rhinosinusitis were observed; all patients underwent extended endoscopic polysinusotomy. According to clinical studies, Isofra nasal spray is highly effective and safe in the treatment of patients with infectious diseases of the nasal cavity, nasopharynx and paranasal sinuses. FINDINGS: The use of Isofra nasal spray (the active ingredient is framycetin sulfate) in our clinic in patients with cystic fibrosis against the background of basic therapy (inhalation with bronchodilators and mucolytics, intranasal topical steroids), had a positive effect on the microbial landscape in the nasal cavity in patients with cystic fibrosis in the postoperative period and allowed to reduce the need for the appointment of systemic antibacterial drugs.


Assuntos
Fibrose Cística , Pólipos Nasais , Rinite , Sinusite , Adulto , Antibacterianos/uso terapêutico , Doença Crônica , Fibrose Cística/tratamento farmacológico , Humanos , Pólipos Nasais/tratamento farmacológico , Rinite/diagnóstico , Rinite/tratamento farmacológico , Sinusite/diagnóstico , Sinusite/tratamento farmacológico
18.
Vestn Otorinolaringol ; 86(4): 73-78, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34499452

RESUMO

Cystic fibrosis is genetic multisystem disorder with a predominant lesion of the respiratory tract. The duration and quality of life of these patients depends on the state of respiratory function. Progressive lung dysfunction is still the leading cause of mortality patients with cystic fibrosis. End-stage lung diseases in patients with cystic fibrosis, lung transplantation is a viable method of treatment. It has the ability to prolong life of these patients. Survival in cystic fibrosis has steadily increased medical treatment and post-transplant. Chronic rhinosinusitis (with nasal polys and without) impacts almost all cystic fibrosis patients, leading to significant reductions in quality of life. Chronic rhinosinusitis with nasal polyps is prevalent in the cystic fibrosis patients, and it is often a recalcitrant infection with multidrug resistant organisms. Medical therapies such as nasal irrigations, nasal steroids, and antibiotics are critical for managing symptoms, but functional endoscopic sinus surgery is necessary for refractory cases. The unified airway hypothesis suggests that sanitation bacterial infection in the upper airway can also decrease bacterial burden in the lungs. The article presents a clinical case of successful endoscopic sinus surgery in a 15-year-old patient with chronic rhinosinusitis with nasal polyps and cystic fibrosis after lung transplantation. The intervention was performed under General anesthesia and controlled hypotension. Bilateral antrostomy, ethmoidectomy and Draf IIb frontal sinusotomy were performed by endoscopic endonasal approach. There were no intra - and post-operative rhinosurgical or lung complications. The follow-up period was 18 months. At present, there is no relapse of chronic polypous rhinosinusitis, and there are no indications for revision intervention.


Assuntos
Fibrose Cística , Transplante de Pulmão , Pólipos Nasais , Rinite , Sinusite , Adolescente , Doença Crônica , Fibrose Cística/complicações , Fibrose Cística/cirurgia , Endoscopia , Humanos , Transplante de Pulmão/efeitos adversos , Qualidade de Vida , Rinite/complicações , Rinite/diagnóstico , Sinusite/complicações , Sinusite/diagnóstico
19.
Vestn Otorinolaringol ; 86(4): 99-105, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34499456

RESUMO

Inflammation of the paranasal sinuses significantly reduces the quality of life of people and causes marked economic damage to society. The striking clinical picture of sinusitis has always forced doctors to study the disease, as evidenced by the first records of the anatomy and diseases of the paranasal sinuses by doctors in ancient Egypt more than 3.000 years BC. Sinusitis has been treated in different ways in different historical periods. Effective medication treatment appeared relatively recently and began to steadily replace the older instrumental methods, to which many people had a preconceived notion of invasiveness. However, many studies are showing the positive effect of active drainage methods and, moreover, there is data showing that the discomfort during such procedures is slightly higher than during dental treatment under local anesthesia. This article presents a review of the available scientific literature on the use of different treatments for bacterial rhinosinusitis at different historical stages, ranging from the first publications on puncture techniques to balloon dilatation and the modern approach to conservative treatment.


Assuntos
Seios Paranasais , Rinite , Sinusite , Doença Crônica , Humanos , Qualidade de Vida , Rinite/diagnóstico , Rinite/terapia , Sinusite/diagnóstico , Sinusite/terapia
20.
Am J Case Rep ; 22: e932787, 2021 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-34426567

RESUMO

BACKGROUND Chronic subdural hematoma is defined as collection in the subdural space for more than 3 weeks. The incidence ranges from 1 to 20 per 100 000/year, with increased prevalence in the elderly, in males, and with use of anticoagulants or antiplatelets. Chronic myeloid leukemia has been linked to spontaneous subdural hematoma, with the highest reported cases of 39 patients in Korea, but no management is mentioned in that paper. There are few reported cases of patients who are medically free with no use of anticoagulants, diagnosed as having a subdural hematoma and then later discovered to have chronic myelogenous leukemia. CASE REPORT We report the case of a 45-year-old man, with known hypertension and diabetes mellitus type 2, on aspirin weekly, who was referred from another hospital with a history of sudden-onset severe headache not related to trauma. Computed tomography (CT) of the brain done in the other hospital showed a left-side subdural hematoma with midline shift. He underwent left-sided acute subdural hematoma evacuation and decompressive hemicraniectomy. He was started on hydroxyurea for chronic myelogenous leukemia. CONCLUSIONS A lesson from this rare case is to look for a differential diagnosis and to keep chronic myelogenous leukemia in mind in patients with leukocytosis. Also, we recommend sending a hematology referral in nontraumatic subdural hematoma. There is no specific treatment or algorithm based on previous research, although from observed data and based on information from the American Heart Association, it is reasonable to perform craniectomy in extra-axial collections of more than 1 cm with midline shift to avoid mortality, as reaching a diagnosis would take too much time.


Assuntos
Hematoma Subdural Agudo , Hematoma Subdural Crônico , Leucemia Mielogênica Crônica BCR-ABL Positiva , Idoso , Encéfalo , Doença Crônica , Hematoma Subdural Agudo/diagnóstico por imagem , Hematoma Subdural Agudo/etiologia , Hematoma Subdural Agudo/cirurgia , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/etiologia , Hematoma Subdural Crônico/cirurgia , Humanos , Leucemia Mielogênica Crônica BCR-ABL Positiva/complicações , Masculino , Pessoa de Meia-Idade , Estados Unidos
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