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1.
Cochrane Database Syst Rev ; 3: CD011675, 2021 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-33734426

RESUMO

BACKGROUND: Leg ulcers are open skin wounds that occur below the knee but above the foot. The majority of leg ulcers are venous in origin, occurring as a result of venous insufficiency, where the flow of blood through the veins is impaired; they commonly arise due to blood clots and varicose veins. Compression therapy, using bandages or stockings, is the primary treatment for venous leg ulcers. Wound cleansing can be used to remove surface contaminants, bacteria, dead tissue and excess wound fluid from the wound bed and surrounding skin, however, there is uncertainty regarding the effectiveness of cleansing and the best method or solution to use. OBJECTIVES: To assess the effects of wound cleansing, wound cleansing solutions and wound cleansing techniques for treating venous leg ulcers. SEARCH METHODS: In September 2019 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA: We considered randomised controlled trials (RCTs) comparing wound cleansing with no wound cleansing, or RCTs comparing different wound cleansing solutions, or different wound cleansing techniques. DATA COLLECTION AND ANALYSIS: We screened studies for their appropriateness for inclusion, assessed their risk of bias using the Cochrane 'Risk of bias' tool, and used GRADE methodology to determine the certainty of evidence. Two review authors undertook these tasks independently, using predetermined criteria. We contacted study authors for missing data where possible. MAIN RESULTS: We included four studies with a total of 254 participants. All studies included comparisons between different types of cleansing solutions, and three of these reported our primary outcomes of complete wound healing or change in ulcer size over time, or both. Two studies reported the secondary outcome, pain. One study (27 participants), which compared polyhexamethylene biguanide (PHMB) solution with saline solution for cleansing venous leg ulcers, did not report any of the review's primary or secondary outcomes. We did not identify any studies that compared cleansing with no cleansing, or that explored comparisons between different cleansing techniques. One study (61 participants) compared aqueous oxygen peroxide with sterile water. We are uncertain whether aqueous oxygen peroxide makes any difference to the number of wounds completely healed after 12 months of follow-up (risk ratio (RR) 1.88, 95% confidence interval (CI) 1.10 to 3.20). Similarly, we are uncertain whether aqueous oxygen peroxide makes any difference to change in ulcer size after eight weeks of follow-up (mean difference (MD) -1.38 cm2, 95% CI -4.35 to 1.59 cm2). Finally, we are uncertain whether aqueous oxygen peroxide makes any difference to pain reduction, assessed after eight weeks of follow-up using a 0 to 100 pain rating, (MD 3.80, 95% CI -10.83 to 18.43). The evidence for these outcomes is of very low certainty (we downgraded for study limitations and imprecision; for the pain outcome we also downgraded for indirectness). Another study (40 participants) compared propyl betaine and polihexanide with a saline solution. The authors did not present the raw data in the study report so we were unable to conduct independent statistical analysis of the data. We are uncertain whether propyl betaine and polihexanide make any difference to the number of wounds completely healed, change in ulcer size over time, or wound pain reduction. The evidence is of very low certainty (we downgraded for study limitations and imprecision). The final study (126 participants) compared octenidine dihydrochloride/phenoxyethanol (OHP) with Ringer's solution. We are uncertain whether OHP makes any difference to the number of wounds healed (RR 0.96, 95% CI 0.53 to 1.72) or to the change in ulcer size over time (we were unable to conduct independent statistical analysis of available data). The evidence is of very low certainty (we downgraded for study limitations and imprecision). None of the studies reported patient preference, ease of use of the method of cleansing, cost or health-related quality of life. In one study comparing propyl betaine and polihexanide with saline solution the authors do not report any adverse events occurring. We are uncertain whether OHP makes any difference to the number of adverse events compared with Ringer's solution (RR 0.58, 95% CI 0.29 to 1.14). The evidence is of very low certainty (we downgraded for study limitations and imprecision). AUTHORS' CONCLUSIONS: There is currently a lack of RCT evidence to guide decision making about the effectiveness of wound cleansing compared with no cleansing and the optimal approaches to cleansing of venous leg ulcers. From the four studies identified, there is insufficient evidence to demonstrate whether the use of PHMB solution compared with saline solution; aqueous oxygen peroxide compared with sterile water; propyl betaine and polihexanide compared with a saline solution; or OHP compared with Ringer's solution makes any difference in the treatment of venous leg ulcers. Evidence from three of the studies is of very low certainty, due to study limitations and imprecision. One study did not present data for the primary or secondary outcomes. Further well-designed studies that address important clinical, quality of life and economic outcomes may be important, based on the clinical and patient priority of this uncertainty.


Assuntos
Desinfetantes/uso terapêutico , Úlcera Varicosa/terapia , Cicatrização/efeitos dos fármacos , Idoso , Anti-Infecciosos Locais/uso terapêutico , Betaína/uso terapêutico , Viés , Biguanidas/uso terapêutico , Intervalos de Confiança , Detergentes/uso terapêutico , Etilenoglicóis/uso terapêutico , Feminino , Humanos , Peróxido de Hidrogênio/uso terapêutico , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Piridinas/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Solução de Ringer/uso terapêutico , Solução Salina/uso terapêutico , Úlcera Varicosa/patologia
2.
BMC Surg ; 21(1): 56, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33482784

RESUMO

BACKGROUND: Synchronous multicentric osteosarcoma (SMOS) is a rare disease characterized by simultaneous multicentricity of intraosseous osteosarcoma without visceral involvement. SMOS, including a skull lesion, which occurs relatively rarely, and reconstruction using a frozen autograft after the excision of a lesion of SMOS has been infrequently reported previously. CASE PRESENTATION: We report an 18-year-old girl with SMOS, with lesions located in the left distal femur, right proximal humerus, and left occipital bone. Her major complaint was pain and swelling around the left knee joint. Asymptomatic lesions of the humerus and skull bone were detected on a systemic bone scan. No visceral organ metastasis was observed. A biopsy of the distal femoral lesion revealed osteosarcoma. Based on the histological findings, multiple bone lesions, and absence of visceral lesion, the clinical diagnosis of SMOS was made. After five courses of neoadjuvant chemotherapy with a regimen of doxorubicin and cisplatin, reconstruction using a tumor prosthesis following wide excision of the left distal femur was performed, and total necrosis was histologically observed in the retracted specimen. Following three cycles of adjuvant chemotherapy, tumor excision and reconstruction with a frozen autograft treated with liquid nitrogen was conducted for both lesions of the humerus and skull, rather than tumor prosthesis or synthetics, in order to retain a normal shoulder function, and to obtain a good cosmetic and functional outcome after treatment of the skull lesion. Further adjuvant chemotherapy could not be administered after the completion of the surgical treatment for all lesions because the adverse events due to chemotherapy were observed. At over 5 years after the diagnosis, she remains clinically disease-free. CONCLUSIONS: An early correct diagnosis, the proper management of chemotherapy, and surgical treatment for all lesions are essential for achieving a good clinical outcome, even in SMOS including a skull lesion. By performing reconstruction using a frozen autograft for a proximal humeral lesion and a skull lesion after confirming the good histological efficacy of neoadjuvant chemotherapy for the primary lesion, the excellent function of the shoulder joint and a good cosmetic outcome at the site of the skull lesion was acquired without complications or recurrence.


Assuntos
Neoplasias Ósseas , Crioterapia , Úmero , Neoplasias Primárias Múltiplas , Osso Occipital , Osteossarcoma , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Autoenxertos , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/cirurgia , Cisplatino/administração & dosagem , Protocolos Clínicos , Terapia Combinada , Crioterapia/métodos , Doxorrubicina/administração & dosagem , Feminino , Neoplasias Femorais/diagnóstico por imagem , Neoplasias Femorais/tratamento farmacológico , Neoplasias Femorais/cirurgia , Humanos , Úmero/diagnóstico por imagem , Úmero/cirurgia , Úmero/transplante , Iodo/uso terapêutico , Terapia Neoadjuvante , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/tratamento farmacológico , Neoplasias Primárias Múltiplas/cirurgia , Nitrogênio/uso terapêutico , Osso Occipital/diagnóstico por imagem , Osso Occipital/cirurgia , Osso Occipital/transplante , Osteossarcoma/diagnóstico por imagem , Osteossarcoma/tratamento farmacológico , Osteossarcoma/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Solução Salina/uso terapêutico , Neoplasias Cranianas/diagnóstico por imagem , Neoplasias Cranianas/tratamento farmacológico , Neoplasias Cranianas/cirurgia , Transplante Autólogo/métodos
3.
BMJ ; 370: m3027, 2020 09 09.
Artigo em Inglês | MEDLINE | ID: mdl-33315586

RESUMO

OBJECTIVE: To study whether a high volume injection without corticosteroids improves clinical outcome in addition to usual care for adults with chronic midportion Achilles tendinopathy. DESIGN: Patient and assessor blinded, placebo controlled randomised clinical trial. SETTING: Sports medicine department of a large district general hospital, the Netherlands. PARTICIPANTS: 80 adults (aged 18-70 years) with clinically diagnosed chronic midportion Achilles tendinopathy and neovascularisation on ultrasonography. 39 were randomised to a high volume injection without corticosteroids and 41 to placebo. INTERVENTIONS: Participants were instructed to perform an exercise programme for 24 weeks (usual care) combined with one 50 mL high volume injection of saline and lidocaine (intervention group) or one 2 mL placebo injection of saline and lidocaine (placebo group) at baseline. MAIN OUTCOME MEASURES: Primary outcome was pain and function assessed using the validated Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire at 24 weeks (analysed using a generalised estimation equations model). Secondary outcomes were patient satisfaction, return to sport, degree of ultrasonographic Doppler flow, visual analogue scale on 10 hop test, power and flexibility of the gastrocnemius and soleus muscles, pain detect questionnaire for neuropathic pain, and pain coping inventory. Participants were evaluated at baseline and at 2, 6, 12, and 24 weeks. RESULTS: Only one participant (1%) was lost to follow-up. The estimated mean VISA-A score improved significantly, from 40.4 (95% confidence interval 32.0 to 48.7) at baseline to 59.1 (50.4 to 67.8) at 24 weeks in the high volume injection group and from 36.9 (27.1 to 46.8) to 58.5 (47.9 to 69.1) in the placebo group. The VISA-A score over time did not differ between the groups (adjusted between group difference at 24 weeks 0.5 points, 95% confidence interval -17.8 to 18.8). No significant between group differences were found for patient satisfaction (21/37 (57%) v 19/39 (49%) patients, P=0.50) and return to desired sport (15/29 (52%) v 19/31 (61%) patients active in sports, P=0.65) at 24 weeks. None of the other secondary outcomes differed between the two groups. CONCLUSIONS: A high volume injection without corticosteroids in addition to usual care is not effective for symptom reduction in patients with chronic midportion Achilles tendinopathy. On the basis of our findings, we cannot recommend the use of a high volume injection in this patient group. TRIAL REGISTRATION: ClinicalTrials.gov NCT02996409.


Assuntos
Tendão do Calcâneo , Anestésicos Locais/administração & dosagem , Lidocaína/administração & dosagem , Solução Salina/administração & dosagem , Tendinopatia/tratamento farmacológico , Adolescente , Adulto , Idoso , Anestésicos Locais/uso terapêutico , Doença Crônica , Terapia Combinada , Relação Dose-Resposta a Droga , Método Duplo-Cego , Quimioterapia Combinada , Terapia por Exercício , Feminino , Seguimentos , Humanos , Injeções , Lidocaína/uso terapêutico , Masculino , Pessoa de Meia-Idade , Solução Salina/uso terapêutico , Tendinopatia/diagnóstico , Tendinopatia/terapia , Resultado do Tratamento , Adulto Jovem
4.
Cochrane Database Syst Rev ; 12: CD012965, 2020 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-33316083

RESUMO

BACKGROUND: Acute bronchiolitis is a significant burden on children, their families and healthcare facilities. It mostly affects children younger than two years of age. Treatment involves adequate hydration, humidified oxygen supplementation, and nebulisation of medications, such as salbutamol, epinephrine, and hypertonic saline. The effectiveness of magnesium sulphate for acute bronchiolitis is unclear. OBJECTIVES: To assess the effects of magnesium sulphate in acute bronchiolitis in children up to two years of age. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, LILACS, CINAHL, and two trials registries to 30 April 2020. We contacted trial authors to identify additional studies. We searched conference proceedings and reference lists of retrieved articles. Unpublished and published studies were eligible for inclusion. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs, comparing magnesium sulphate, alone or with another treatment, with placebo or another treatment, in children up to two years old with acute bronchiolitis. Primary outcomes were time to recovery, mortality, and adverse events. Secondary outcomes were duration of hospital stay, clinical severity score at 0 to 24 hours and 25 to 48 hours after treatment, pulmonary function test, hospital readmission within 30 days, duration of mechanical ventilation, and duration of intensive care unit stay. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We used GRADE methods to assess the certainty of the evidence. MAIN RESULTS: We included four RCTs (564 children). One study received funding from a hospital and one from a university; two studies did not report funding sources. Comparator interventions differed among all four trials. Studies were conducted in Qatar, Turkey, Iran, and India. We assessed two studies to be at an overall low risk of bias, and two to be at unclear risk of bias, overall. The certainty of the evidence for all outcomes and comparisons was very low except for one: hospital re-admission rate within 30 days of discharge for magnesium sulphate versus placebo. None of the studies measured time to recovery, duration of mechanical ventilation, duration of intensive care unit stay, or pulmonary function. There were no events of mortality or adverse effects for magnesium sulphate compared with placebo (1 RCT, 160 children). The effects of magnesium sulphate on clinical severity are uncertain (at 0 to 24 hours: mean difference (MD) on the Wang score 0.13, 95% confidence interval (CI) -0.28 to 0.54; and at 25 to 48 hours: MD on the Wang score -0.42, 95% CI -0.84 to -0.00). Magnesium sulphate may increase hospital re-admission rate within 30 days of discharge (risk ratio (RR) 3.16, 95% CI 1.20 to 8.27; 158 children; low-certainty evidence). None of our primary outcomes were measured for magnesium sulphate compared with hypertonic saline (1 RCT, 220 children). Effects were uncertain on the duration of hospital stay in days (MD 0.00, 95% CI -0.28 to 0.28), and on clinical severity on the Respiratory Distress Assessment Instrument (RDAI) score at 25 to 48 hours (MD 0.10, 95% CI -0.39 to 0.59). There were no events of mortality or adverse effects for magnesium sulphate, with or without salbutamol, compared with salbutamol (1 RCT, 57 children). Effects on the duration of hospital stay were uncertain (magnesium sulphate: 24 hours (95% CI 25.8 to 47.4), magnesium sulphate + salbutamol: 20 hours (95% CI 15.3 to 39.0), and salbutamol: 24 hours (95% CI 23.4 to 76.9)). None of our primary outcomes were measured for magnesium sulphate + epinephrine compared with no treatment or normal saline + epinephrine (1 RCT,120 children). Effects were uncertain for the duration of hospital stay in hours (MD -0.40, 95% CI -3.94 to 3.14), and for RDAI scores (0 to 24 hours: MD -0.20, 95% CI -1.06 to 0.66; and 25 to 48 hours: MD -0.90, 95% CI -1.75 to -0.05). AUTHORS' CONCLUSIONS: There is insufficient evidence to establish the efficacy and safety of magnesium sulphate for treating children up to two years of age with acute bronchiolitis. No evidence was available for time to recovery, duration of mechanical ventilation and intensive care unit stay, or pulmonary function. There was no information about adverse events for some comparisons. Well-designed RCTs to assess the effects of magnesium sulphate for children with acute bronchiolitis are needed. Important outcomes, such as time to recovery and adverse events should be measured.


Assuntos
Bronquiolite/tratamento farmacológico , Broncodilatadores/uso terapêutico , Sulfato de Magnésio/uso terapêutico , Doença Aguda , Albuterol/uso terapêutico , Viés , Broncodilatadores/administração & dosagem , Quimioterapia Combinada/métodos , Epinefrina/uso terapêutico , Humanos , Lactente , Recém-Nascido , Tempo de Internação , Sulfato de Magnésio/administração & dosagem , Readmissão do Paciente/estatística & dados numéricos , Placebos/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Solução Salina/uso terapêutico , Índice de Gravidade de Doença
5.
PLoS One ; 15(7): e0235084, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614837

RESUMO

Hemorrhagic shock is one of the leading causes of mortality and morbidity in pediatric trauma. Current treatment based on volume resuscitation is associated to adverse effects, and it has been proposed that vasopressors may be used in the pharmacological management of trauma. Terlipressin has demonstrated its usefulness in other pediatric critical care scenarios and its long half-life allows its use as a bolus in an outpatient critical settings. The aim of this study was to analyze whether the addition of a dose of terlipressin to the initial volume expansion produces an improvement in hemodynamic and cerebral perfusion at early stages of hemorrhagic shock in an infant animal model. We conducted an experimental randomized animal study with 1-month old pigs. After 30 minutes of hypotension (mean arterial blood pressure [MAP]<45 mmHg) induced by the withdrawal of blood over 30 min, animals were randomized to receive either normal saline (NS) 30 mL/kg (n = 8) or a bolus of 20 mcg/kg of terlipressin plus 30 mL/kg of normal saline (TP) (n = 8). Global hemodynamic and cerebral monitoring parameters, brain damage markers and histology samples were compared. After controlled bleeding, significant decreases were observed in MAP, cardiac index (CI), central venous pressure, global end-diastolic volume index (GEDI), left cardiac output index, SvO2, intracranial pressure, carotid blood flow, bispectral index (BIS), cerebral perfusion pressure (CPP) and increases in systemic vascular resistance index, heart rate and lactate. After treatment, MAP, GEDI, CI, CPP and BIS remained significantly higher in the TP group. The addition of a dose of terlipressin to initial fluid resuscitation was associated with hemodynamic improvement, intracranial pressure maintenance and better cerebral perfusion, which would mean protection from ischemic injury. Brain monitoring through BIS was able to detect changes caused by hemorrhagic shock and treatment.


Assuntos
Hemodinâmica/efeitos dos fármacos , Solução Salina/uso terapêutico , Choque Hemorrágico/terapia , Terlipressina/uso terapêutico , Vasoconstritores/uso terapêutico , Animais , Animais Recém-Nascidos , Circulação Cerebrovascular/efeitos dos fármacos , Modelos Animais de Doenças , Hidratação , Masculino , Ressuscitação , Choque Hemorrágico/sangue , Choque Hemorrágico/fisiopatologia , Suínos
6.
BMJ Case Rep ; 13(7)2020 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-32675133

RESUMO

We describe a 40-year-old woman with severe, persistent macroglossia following prone positioning as part of treatment for COVID-19. We used the treatment method of lingual compression with satisfactory results.


Assuntos
Betacoronavirus , Bandagens Compressivas , Infecções por Coronavirus/complicações , Macroglossia/complicações , Macroglossia/terapia , Posicionamento do Paciente/métodos , Pneumonia Viral/complicações , Doença Aguda , Adulto , Feminino , Humanos , Macroglossia/etiologia , Pandemias , Posicionamento do Paciente/efeitos adversos , Solução Salina/uso terapêutico , Língua
7.
Zhonghua Nei Ke Za Zhi ; 59(6): 460-463, 2020 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-32486587

RESUMO

To evaluate the effects of resuscitation with normal saline and sodium potassium magnesium calcium and glucose injection on renal structure and function in septic rats. Rat model of sepsis was established by ligation and perforation of cecum. Male SD rats were divided into four groups: sham operation group, sepsis group, saline resuscitation group, sodium potassium magnesium calcium and glucose injection resuscitation group. Blood gas analysis was performed at the end of resuscitation. The rats were sacrificed 72 hours after resuscitation. Blood samples were taken to measure the plasma levels of blood urea nitrogen (BUN), creatinine, interleukin-1ß (IL-1ß), interleukin-6 (IL-6) and tumor necrosis factorα (TNFα). Caspase-3 expression was detected by immunohistochemistry in kidney sections. The degree of renal injury was evaluated by regular HE staining and electron microscope. Compared with normal saline resuscitation, sodium potassium calcium magnesium glucose injection resuscitation could decrease the levels of BUN, serum creatinine, IL-1ß, IL-6 and TNFα (P<0.05) , reduce the expression of caspase-3 (P<0.05) , and improve the renal injury score (P<0.05) . Sodium potassium calcium magnesium glucose injection resuscitation can significantly improve the renal function of sepsis rats with less pathological damage of the kidney.


Assuntos
Lesão Renal Aguda/terapia , Soluções Cristaloides/uso terapêutico , Solução Salina/uso terapêutico , Sepse/complicações , Animais , Soluções Cristaloides/administração & dosagem , Rim , Masculino , Ratos , Ratos Sprague-Dawley , Solução Salina/administração & dosagem , Sepse/terapia , Fator de Necrose Tumoral alfa
8.
Pediatr Rev ; 41(6): 265-275, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32482689

RESUMO

Pediatric rhabdomyolysis is a common diagnosis that pediatricians need to be able to recognize because prompt treatment can prevent potential complications, such as acute kidney injury. The triggers for rhabdomyolysis are extensive, with viruses being the most common cause in pediatric patients. The pathophysiology behind rhabdomyolysis is complex and still being researched, but having a firm understanding of the cascade that results when muscle injury occurs is essential for proper management. Guidelines for managing pediatric rhabdomyolysis currently do not exist, but this article aims to review the available literature and give clinicians a general approach to aid in history taking, physical examination, diagnosis, acute management, follow-up, and prevention.


Assuntos
Rabdomiólise , Solução Salina/uso terapêutico , Algoritmos , Biomarcadores/sangue , Criança , Creatina Quinase/sangue , Exercício Físico/fisiologia , Humanos , Infecções/complicações , Rabdomiólise/diagnóstico , Rabdomiólise/etiologia , Rabdomiólise/fisiopatologia , Rabdomiólise/terapia
9.
Eur J Endocrinol ; 183(1): G9-G15, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32380474

RESUMO

COVID-19 has changed the nature of medical consultations, emphasizing virtual patient counseling, with relevance for patients with diabetes insipidus (DI) or hyponatraemia. The main complication of desmopressin treatment in DI is dilutional hyponatraemia. Since plasma sodium monitoring is not always possible in times of COVID-19, we recommend to delay the desmopressin dose once a week until aquaresis occurs allowing excess retained water to be excreted. Patients should measure their body weight daily. Patients with DI admitted to the hospital with COVID-19 have a high risk for mortality due to volume depletion. Specialists must supervise fluid replacement and dosing of desmopressin. Patients after pituitary surgery should drink to thirst and measure their body weight daily to early recognize the development of the postoperative syndrome of inappropriate antidiuresis (SIAD). They should know hyponatraemia symptoms. The prevalence of hyponatraemia in patients with pneumonia due to COVID-19 is not yet known, but seems to be low. In contrast, hypernatraemia may develop in COVID-19 patients in ICU, from different multifactorial reasons, for example, due to insensible water losses from pyrexia, increased respiration rate and use of diuretics. Hypernatraemic dehydration may contribute to the high risk of acute kidney injury in COVID-19. IV fluid replacement should be administered with caution in severe cases of COVID-19 because of the risk of pulmonary oedema.


Assuntos
Antidiuréticos/administração & dosagem , Infecções por Coronavirus/terapia , Desamino Arginina Vasopressina/administração & dosagem , Diabetes Insípido Neurogênico/terapia , Hidratação/métodos , Hipernatremia/terapia , Hiponatremia/terapia , Síndrome de Secreção Inadequada de HAD/terapia , Pneumonia Viral/terapia , Lesões Encefálicas/complicações , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Desidratação/terapia , Diabetes Insípido/complicações , Diabetes Insípido/terapia , Diabetes Insípido Neurogênico/complicações , Gerenciamento Clínico , Humanos , Hiponatremia/etiologia , Hiponatremia/prevenção & controle , Soluções Hipotônicas/uso terapêutico , Procedimentos Neurocirúrgicos , Pandemias/prevenção & controle , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Complicações Pós-Operatórias/terapia , Guias de Prática Clínica como Assunto , Solução Salina/uso terapêutico , Choque/etiologia , Choque/terapia
10.
BMC Oral Health ; 20(1): 86, 2020 03 24.
Artigo em Inglês | MEDLINE | ID: mdl-32204705

RESUMO

BACKGROUND: The aim of the present study was to evaluate the effectiveness of intraductal irrigation using normal saline in chronic obstructive sialadenitis. METHODS: Patients who had one of the following symptoms were recruited: pain, swelling, stiffness, and dry mouth. A total of 58 salivary glands in 33 patients were diagnosed as having sialadenitis using sialography and ultrasonography. The patients were divided into two groups (swelling group and dry mouth group), according to the major complaint. Repeated intraductal irrigation was performed on each gland. Difference of symptom severity evaluated using numerical rating scale (NRS), and ductal width measured using ultrasonography were compared between the two groups. RESULTS: The average NRS score was significantly decreased from 6.0 to 3.3 after 3-5 visits of intraductal irrigation (P < 0.05). The reduction in NRS was greater in the swelling group than in the dry mouth group, although the difference between the groups was not statistically significant. There was no change of ductal width before and after the irrigation. CONCLUSIONS: Intraductal irrigation according to this study method using normal saline is a simple treatment for the patients with chronic obstructive sialadenitis. It provides a conservative treatment option reducing the subjective symptoms.


Assuntos
Solução Salina/uso terapêutico , Glândulas Salivares/diagnóstico por imagem , Sialadenite/tratamento farmacológico , Sialografia/métodos , Irrigação Terapêutica , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Humanos , Pessoa de Meia-Idade , Sialadenite/diagnóstico , Resultado do Tratamento , Ultrassonografia , Xerostomia/etiologia
11.
J. coloproctol. (Rio J., Impr.) ; 40(1): 8-11, Jan.-Mar. 2020.
Artigo em Inglês | LILACS | ID: biblio-1090847

RESUMO

Abstract Introduction Peritoneal antibiotic or normal saline lavage is seen to be beneficial in order to reduce the pain or infection risk through laparoscopic surgeries. It can also be applied for laparoscopic colectomy surgeries. In this study, we have compared the effects of antibiotic solution lavage (gentamycin-clindamycin) with normal saline lavage in patients undergoing laparoscopic colectomy surgery. Method In this double-blind Randomized Controlled Trial (RCT), 40 patients undergoing laparoscopic colectomy surgery were divided into antibiotic and normal saline lavage groups (20 patients in each group). Post-operational pain, need for painkiller, white blood cells count, C-reactive protein level, duration of hospitalization and wound infection were compared in 30 days between the groups. Results Antibiotic lavage group had significantly less pain than the normal saline group (p < 0.05) through 3, 6, 12 and 24 h after surgery. C-reactive protein level, white blood cells count, painkiller use, and hospitalization duration were significantly lower in antibiotic group. However, there was no difference regarding wound or intra-abdominal infection between the both groups. Conclusion Using gentamicin-clindamycin peritonea lavage helps patients undergoing laparoscopic colectomy surgery in pain reduction, need for painkillers and hospitalization duration.


Resumo Introdução A lavagem peritoneal com antibiótico ou com soro fisiológico normal é benéfica para reduzir o risco de dor ou de infecção durante cirurgias laparoscópicas, além de poder ser aplicada também em colectomias laparoscópicas. Neste estudo, comparamos os efeitos da lavagem com solução antibiótica (gentamicina-clindamicina) e da lavagem com solução salina normal em pacientes submetidos à colectomia laparoscópica. Método Neste Ensaio Clínico Randomizado (ECR), controlado e duplo-cego, 40 pacientes submetidos à colectomia laparoscópica foram divididos em dois grupos (20 pacientes em cada grupo) para receberem antibiótico ou solução salina normal. Dor pós-operatória, necessidade de analgésico, contagem de leucócitos, nível de proteína C-reativa, tempo de internação e infecção da ferida foram comparados entre os grupos em 30 dias. Resultados De forma significativa, o Grupo Antibiótico apresentou menos dor que o Grupo Salina Normal (p < 0,05) em 3, 6, 12 e 24 horas após a cirurgia. O nível de proteína C-reativa, a contagem de leucócitos, o uso de analgésicos e o tempo de internação foram significativamente menores no Grupo Antibiótico. Porém, não houve diferença em relação à infecção da ferida ou intra-abdominal entre os dois grupos. Conclusão O uso da lavagem peritoneal com gentamicina-clindamicina ajuda a reduzir a dor, a necessidade de analgésicos e o tempo de internação de pacientes submetidos à colectomia laparoscópica.


Assuntos
Humanos , Dor Pós-Operatória/tratamento farmacológico , Infecção da Ferida Cirúrgica/tratamento farmacológico , Lavagem Peritoneal , Laparoscopia , Colectomia/métodos , Antibacterianos/uso terapêutico , Clindamicina/uso terapêutico , Gentamicinas/uso terapêutico , Método Duplo-Cego , Solução Salina/uso terapêutico , Tempo de Internação
12.
J Cardiothorac Surg ; 15(1): 34, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-32041642

RESUMO

BACKGROUND: This study aims to compare the effects of storage solutions commonly used in coronary artery bypass grafting on the vascular reactivity in vein graft interposed in arterial position in syngeneic rats. METHODS: Twenty-seven male Lewis rats were sacrified to sample a vein graft implanted 6 weeks ago into abdominal aorta position. The vein grafts were inferior venae cavae initially pretreated with heparinized saline solution (HS) or autologous heparinized blood (AHB) or our referent solution, GALA. The endothelial functionality, the in situ Reactive Oxygen Species (ROS) levels and the histological characteristics were conducted from segments of arterialized vein graft. RESULTS: At 6 weeks, graft thrombosis occurred respectively in 22% of AHB group, 62.5% in the HS group and 82.5% in the GALA group. In each group, significative intimal hyperplasia was observed. After 6 weeks, an endothelium-remodeling layer associated with an increase of wall thickness was observed in each group. Endothelium-dependent tone was reduced in the vein graft regardless of the group. No difference was observed concerning the ROS in vein graft between the different groups. In distal aortic sections, ROS levels were increased in HS and GALA groups. CONCLUSIONS: Storage solutions used in this experimental model of vein graft implanted in arterial position cause graft injury and a complete disappearance of vascular reactivity. GALA solution did not reduce intimal risk hyperplasia when the vein graft was exposed to arterial flow in a rat model.


Assuntos
Aorta Abdominal/cirurgia , Ponte de Artéria Coronária , Endotélio Vascular/efeitos dos fármacos , Soluções para Preservação de Órgãos/farmacologia , Túnica Íntima/patologia , Veia Cava Inferior/transplante , Animais , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Sangue , Modelos Animais de Doenças , Endotélio Vascular/patologia , Heparina/administração & dosagem , Heparina/uso terapêutico , Hiperplasia , Masculino , Soluções para Preservação de Órgãos/administração & dosagem , Soluções para Preservação de Órgãos/uso terapêutico , Ratos , Ratos Endogâmicos Lew , Espécies Reativas de Oxigênio/análise , Solução Salina/administração & dosagem , Solução Salina/uso terapêutico , Túnica Íntima/efeitos dos fármacos , Veia Cava Inferior/efeitos dos fármacos
13.
Crit Care ; 24(1): 1, 2020 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-31898531

RESUMO

BACKGROUND: Acute kidney injury (AKI) is an important complication encountered during the course of diabetic ketoacidosis (DKA). Plasma-Lyte with lower chloride concentration than saline has been shown to be associated with reduced incidence of AKI in adults with septic shock. No study has compared this in DKA. METHODS: This double-blind, parallel-arm, investigator-initiated, randomized controlled trial compared 0.9% saline with Plasma-Lyte-A as initial fluid in pediatric DKA. The study was done in a tertiary care, teaching, and referral hospital in India in children (> 1 month-12 years) with DKA as defined by ISPAD. Children with cerebral edema or known chronic kidney/liver disease or who had received pre-referral fluids and/or insulin were excluded. Sixty-six children were randomized to receive either Plasma-Lyte (n = 34) or 0.9% saline (n = 32). MAIN OUTCOMES: Primary outcome was incidence of new or progressive AKI, defined as a composite outcome of change in creatinine (defined by KDIGO), estimated creatinine clearance (defined by p-RIFLE), and NGAL levels. The secondary outcomes were resolution of AKI, time to resolution of DKA (pH > 7.3, bicarbonate> 15 mEq/L & normal sensorium), change in chloride, pH and bicarbonate levels, proportion of in-hospital all-cause mortality, need for renal replacement therapy (RRT), and length of ICU and hospital stay. RESULTS: Baseline characteristics were similar in both groups. The incidence of new or progressive AKI was similar in both [Plasma-Lyte 13 (38.2%) versus 0.9% saline 15 (46.9%); adjusted OR 1.22; 95% CI 0.43-3.43, p = 0.70]. The median (IQR) time to resolution of DKA in Plasma-Lyte-A and 0.9% saline were 14.5 (12 to 20) and 16 (8 to 20) h respectively. Time to resolution of AKI was similar in both [Plasma-Lyte 22.1 versus 0.9% saline 18.8 h (adjusted HR 1.72; 95% CI 0.83-3.57; p = 0.14)]. Length of hospital stay was also similar in both [Plasma-Lyte 9 (8 to 12) versus 0.9% saline 10 (8.25 to 11) days; p = 0.39]. CONCLUSIONS: The incidence of new or progressive AKI and resolution of AKI were similar in both groups. Plasma-Lyte-A was similar to 0.9% Saline in time to resolution of DKA, need for RRT, mortality, and lengths of PICU and hospital stay. TRIAL REGISTRATION: Clinical trial registry of India, CTRI/2018/05/014042 (ctri.nic.in) (Retrospectively registered).


Assuntos
Lesão Renal Aguda/tratamento farmacológico , Cetoacidose Diabética/tratamento farmacológico , Solução Salina/normas , Lesão Renal Aguda/prevenção & controle , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Gluconatos/normas , Gluconatos/uso terapêutico , Humanos , Índia , Cloreto de Magnésio/normas , Cloreto de Magnésio/uso terapêutico , Masculino , Medicina de Emergência Pediátrica/métodos , Cloreto de Potássio/normas , Cloreto de Potássio/uso terapêutico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Solução Salina/uso terapêutico , Acetato de Sódio/normas , Acetato de Sódio/uso terapêutico , Cloreto de Sódio/normas , Cloreto de Sódio/uso terapêutico
14.
J Vet Sci ; 21(1): e6, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31940685

RESUMO

Currently, the optimal resuscitation fluid remains debatable. Therefore, in the present study, we designed a trometamol-balanced solution (TBS) for use as a resuscitation fluid for hemorrhagic shock. Hemorrhagic shock was induced in 18 male Wistar-Kyoto rats, which were assigned to normal saline (NS), Ringer's solution (RS), and TBS groups. During the hemorrhagic state, their hemodynamic parameters were recorded using an Abbott i-STAT analyzer with the CG4+ cartridge (for pH, pressure of carbon dioxide, pressure of oxygen, total carbon dioxide, bicarbonate, base excess, oxygen saturation, and lactate), the CG6+ cartridge (for sodium, potassium, chloride, blood glucose, blood urea nitrogen, hematocrit, and hemoglobin), and enzyme-linked immunosorbent assay kits (calcium, magnesium, creatinine, aspartate aminotransferase, alanine aminotransferase, bilirubin, and albumin). Similar trends were found for the parameters of biochemistries, electrolytes, and blood gas, and they revealed no significant changes after blood withdrawal-induced hemorrhagic shock. However, the TBS group showed more effective ability to correct metabolic acidosis than the NS and RS groups. TBS was a feasible and safe resuscitation solution in this study and may be an alternative to NS and RS for resuscitation in hemorrhagic shock patients without liver damage.


Assuntos
Hidratação/instrumentação , Solução de Ringer/uso terapêutico , Choque Hemorrágico/terapia , Trometamina/uso terapêutico , Animais , Tampões (Química) , Soluções Cristaloides/uso terapêutico , Modelos Animais de Doenças , Masculino , Distribuição Aleatória , Ratos , Solução Salina/uso terapêutico
15.
JAMA ; 323(3): 225-236, 2020 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-31961418

RESUMO

Importance: It is not known if use of colloid solutions containing hydroxyethyl starch (HES) to correct for intravascular deficits in high-risk surgical patients is either effective or safe. Objective: To evaluate the effect of HES 130/0.4 compared with 0.9% saline for intravascular volume expansion on mortality and postoperative complications after major abdominal surgery. Design, Setting, and Participants: Multicenter, double-blind, parallel-group, randomized clinical trial of 775 adult patients at increased risk of postoperative kidney injury undergoing major abdominal surgery at 20 university hospitals in France from February 2016 to July 2018; final follow-up was in October 2018. Interventions: Patients were randomized to receive fluid containing either 6% HES 130/0.4 diluted in 0.9% saline (n = 389) or 0.9% saline alone (n = 386) in 250-mL boluses using an individualized hemodynamic algorithm during surgery and for up to 24 hours on the first postoperative day, defined as ending at 7:59 am the following day. Main Outcomes and Measures: The primary outcome was a composite of death or major postoperative complications at 14 days after surgery. Secondary outcomes included predefined postoperative complications within 14 days after surgery, durations of intensive care unit and hospital stays, and all-cause mortality at postoperative days 28 and 90. Results: Among 826 patients enrolled (mean age, 68 [SD, 7] years; 91 women [12%]), 775 (94%) completed the trial. The primary outcome occurred in 139 of 389 patients (36%) in the HES group and 125 of 386 patients (32%) in the saline group (difference, 3.3% [95% CI, -3.3% to 10.0%]; relative risk, 1.10 [95% CI, 0.91-1.34]; P = .33). Among 12 prespecified secondary outcomes reported, 11 showed no significant difference, but a statistically significant difference was found in median volume of study fluid administered on day 1: 1250 mL (interquartile range, 750-2000 mL) in the HES group and 1500 mL (interquartile range, 750-2150 mL) in the saline group (median difference, 250 mL [95% CI, 83-417 mL]; P = .006). At 28 days after surgery, 4.1% and 2.3% of patients had died in the HES and saline groups, respectively (difference, 1.8% [95% CI, -0.7% to 4.3%]; relative risk, 1.76 [95% CI, 0.79-3.94]; P = .17). Conclusions and Relevance: Among patients at risk of postoperative kidney injury undergoing major abdominal surgery, use of HES for volume replacement therapy compared with 0.9% saline resulted in no significant difference in a composite outcome of death or major postoperative complications within 14 days after surgery. These findings do not support the use of HES for volume replacement therapy in such patients. Trial Registration: ClinicalTrials.gov Identifier: NCT02502773.


Assuntos
Abdome/cirurgia , Hidratação/métodos , Derivados de Hidroxietil Amido/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Solução Salina/uso terapêutico , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Lesão Renal Aguda/prevenção & controle , Idoso , Método Duplo-Cego , Feminino , Humanos , Cuidados Intraoperatórios , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Estatísticas não Paramétricas
16.
Balkan Med J ; 37(2): 84-90, 2020 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-31818730

RESUMO

Background: In plastic surgery practice, fasciocutaneous single-perforator-pedicled propeller flap is a preferred procedure; however, its survival rate is below than expected, especially in flaps with a big rotation arc. When botulinum toxin-A is injected into the muscle tissue that the perforator pedicle is arisen, the tonus of pertinent muscle can reduce and the blood flow of its perforator pedicle can increase. Therefore this procedure can improve the survival rate of single-perforator-pedicled propeller flap. Aims: To evaluate the effect of botulinum toxin-A injected with ultrasonographic guidance into the muscle tissue that the perforator pedicle is arisen from one month ago on the perfusion of flap scintigraphically and the survival rate of single-perforator-pedicled propeller flap in a rat model. Study Design: Animal experiment. Methods: Three study groups were receiving botulinum toxin-A (16 IU-0.4 mL), normal saline (0.4 mL), and no study drug one month ago before flap surgery. Injections were performed under ultrasonography guidance. Flaps were elevated fasciocutaneously over the right 2nd perforator pedicle, under the corneous, with a surgical loupe and microsurgery tool and were rotated clockwise 180°. Then the scintigraphic measurements were obtained after flap elevations in the study groups, including the whole-body and flap perfusions in the study rats. The involvement rate presents the ratio of flap perfusion to whole-body perfusion. Flaps were sutured back to the abdominal wall at the latest twisting angles. With standard photographs taken in all the groups on day 8 after the operation, whole and necrotic flap areas were calculated. Results: Scintigraphically the involvement rate (the ratio of flap perfusion to whole-body perfusion) of the flaps in the botulinum toxin-A group were found significantly higher than those in the other groups (p<0.05). The area of a flap in the botulinum toxin-A group on day 8 post flap suturing was found to be significantly higher than those in the other groups (p<0.05). The area of a necrosis and the percentage of necrosis on day 8 post flap suturing in the botulinum toxin-A group was found significantly lower than those of the sham and null groups (p<0.05). Conclusion: In a rat model, if with the ultrasonographic guidance, botulinum toxin-A is injected to the muscle which perforator of the prospective single-perforator-pedicled propeller flap originated and flap surgery is performed one month later after this injection, the perfusion of single-perforator-pedicled propeller flap increases scintigraphically and this improves flap survival and reduces its necrosis.


Assuntos
Toxinas Botulínicas Tipo A/farmacologia , Retalho Perfurante/irrigação sanguínea , Perfusão/normas , Análise de Variância , Animais , Toxinas Botulínicas Tipo A/uso terapêutico , Modelos Animais de Doenças , Injeções/métodos , Músculos/efeitos dos fármacos , Retalho Perfurante/cirurgia , Perfusão/estatística & dados numéricos , Cintilografia/métodos , Ratos , Ratos Wistar/cirurgia , Solução Salina/uso terapêutico
17.
J Ultrasound Med ; 39(1): 165-168, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31268176

RESUMO

The aim of this study was to describe a perineural ultrasound-guided infiltration technique for management of radial tunnel syndrome and to report its preliminary results in 54 patients. A mixture of a saline solution, a local anesthetic, and a corticosteroid solution was infiltrated in the perineural region at the arcade of Frohse. Pain was reported in 100% of patients before the procedure versus 1.9% after the procedure. Scratch collapse and Cozen test results were positive in 98.1% and 66.7% of patients before infiltration, respectively, versus 5.6% and 9.2% after infiltration. All variables had statistically significant differences between preprocedure and postprocedure evaluations (P < .01).


Assuntos
Corticosteroides/uso terapêutico , Anestésicos Locais/uso terapêutico , Neuropatia Radial/tratamento farmacológico , Solução Salina/uso terapêutico , Ultrassonografia de Intervenção/métodos , Corticosteroides/administração & dosagem , Anestésicos Locais/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nervo Radial/diagnóstico por imagem , Neuropatia Radial/diagnóstico por imagem , Estudos Retrospectivos , Solução Salina/administração & dosagem , Síndrome , Resultado do Tratamento
19.
Oxid Med Cell Longev ; 2019: 4929107, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31885797

RESUMO

Hemorrhagic shock is caused by massive blood loss. If the patient is not fully resuscitated in time, this may eventually lead to multiple organ failure and even death. Previous studies on methane-rich saline in animal models showed that it confers resistance against many diseases. In this study, we explored the protective effect of methane-rich saline, used as a resuscitation fluid, in hemorrhagic shock. Hemorrhagic shock was induced in SD rats by bloodletting via intubation of the right femoral artery. The rats were divided into three groups: a sham control group (sham control), a shock group resuscitated by an infusion of autologous blood and an equivalent volume of normal saline (Shock+NS), and a shock group resuscitated by an infusion of autologous blood and an equivalent volume of methane-rich saline (Shock+MRS). Assessment of blood pressure and levels of plasma lactate showed that resuscitation using methane-rich saline (MRS) restored systemic blood pressure and reduced the levels of lactate in the plasma. Meanwhile, lower levels of serum IL-6 and TNF-α were also observed in the group resuscitated with MRS. In the heart, liver, and kidney, MRS reduced inflammation and oxidative stress levels. Analysis of organ function via levels of biochemical indicators revealed that the group resuscitated with MRS had reduced serum levels of AST and CK, indicating a potential cardioprotective effect. The expression levels of apoptosis-related proteins, including those of Bcl-2/Bax, and the results of TUNEL-labeling assay indicated that MRS significantly reduced apoptosis in the heart. Methane also had a positive effect on the expression of the PGC-1α/SIRT3/SOD2 signaling pathway. Our results showed that MRS can potentially serve as a novel resuscitation fluid because of its anti-inflammatory, antioxidative, and antiapoptotic properties.


Assuntos
Metano/química , Miocárdio/patologia , Ressuscitação/métodos , Solução Salina/uso terapêutico , Choque Hemorrágico/terapia , Animais , Apoptose , Células Cultivadas , Modelos Animais de Doenças , Artéria Femoral/cirurgia , Humanos , Inflamação , Interleucina-6/metabolismo , Masculino , Proteínas Proto-Oncogênicas c-bcl-2/genética , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Ratos , Ratos Sprague-Dawley , Solução Salina/química , Fator de Necrose Tumoral alfa/metabolismo
20.
Rev. Asoc. Argent. Ortop. Traumatol ; 84(4): 336-341, dic. 2019. []
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1057058

RESUMO

Introducción: La fascitis plantar, descrita, por primera vez, por Plettner, es la causa más común de dolor en el talón. Su etiología continúa en estudio, participan factores anatómicos, como el acortamiento de la flexión plantar, y relacionados con el aumento de peso. Si bien no se ha publicado cuál es el mejor tratamiento para este cuadro, se recomienda el tratamiento conservador temprano. El objetivo de este estudio fue comparar tres métodos de tratamiento de la fascitis plantar. Materiales y Métodos: Entre marzo de 2016 y marzo de 2017, se trató a 90 pacientes con fascitis plantar, quienes fueron divididos en tres grupos, según el tratamiento recibido: grupo A o de control, ejercicios de elongación de la fascia plantar; grupo B, infiltración corticoanestésica y ejercicios de elongación de la fascia plantar, y grupo C, infiltración con solución salina y ejercicios de elongación de la fascia plantar. Resultados: Se mencionan los resultados comparativos sobre la base de la edad, el lado afectado, las enfermedades previas, la forma del pie, las cirugías previas del pie, el dolor posinfiltración, la escala analógica visual: grupo A: 0,73; grupo B: 1,03, grupo C: 2,7 y el tiempo hasta el retorno a la actividad previa: grupo A: 19.1 días, grupo B: 12.63 días, grupo C: 15.12 días. Conclusiones: Nuestro estudio demuestra que los tres tratamientos para la fascitis plantar son eficaces. La recuperación fue más rápida en los pacientes tratados con infiltración corticoanestésica, con un bajo número de complicaciones, pero sin diferencias a largo plazo. Nivel de Evidencia: IV


Objective: Plantar fasciitis, first described by Plettner, is the most common cause of heel pain. The pathophysiology of this condition is still being studied, but it involves both anatomical factors-such as shortening of plantar flexion-and factors related to weight gain. Although literature is not conclusive on the best treatment strategy, early conservative management is recommended. The objective of this study was to compare three treatment regimens for plantar fasciitis. Materials and Methods: Ninety patients with plantar fasciitis were treated between March 2016 and March 2017. They were divided into 3 groups based on the treatment received. Group A (the control group) was managed with plantar fasciitis stretches; Group B was managed with steroid injections and plantar fasciitis stretches; and Group C was managed with saline injections and plantar fasciitis stretches. Results: Results of the comparative study were as follows (reported based on age, affected side, underlying conditions, foot shape, previous foot surgeries, post-injection pain, and visual analog scale scoring): Group A - 0.73, Group B - 1.03, Group C - 2.7. Regarding the time elapsed until patients were able to resume previous activities, results were as follows: Group A - 19.1 days, Group B - 12.63 days, Group C - 15.12 days. Conclusions: Our study showed the effectiveness of the three treatment regimens used. A shorter time to recovery and a lower complication rate were observed in patients treated with steroid injections, but no long-term differences were detected. Level of Evidence: IV


Assuntos
Adulto , Pessoa de Meia-Idade , Idoso , Calcanhar/patologia , Corticosteroides/uso terapêutico , Fasciíte Plantar/terapia , Exercício Físico , Resultado do Tratamento , Solução Salina/uso terapêutico
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