Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.017.368
Filtrar
1.
No Shinkei Geka ; 49(5): 1024-1030, 2021 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-34615762

RESUMO

More than half of the patients with severe head injuries are elderly people in Japan due to the impact of entering a super-aging society. Elderly people take antithrombotic drugs at a high rate. According to the Japan Neurotrauma Data Bank, many patients with head injuries taking antithrombotic drugs sustain falls, indicating an increased risk of deterioration due to low-energy trauma. It has also been pointed out that many hemorrhagic lesions occur due to the effects of antithrombotic drugs, and there is a risk that hematoma will increase later. As an appropriate response in such patients, if bleeding findings are noted on head CT, discontinuation/reversal of antithrombotic drugs should be considered even if the severity is mild. Reversal therapy should be performed in an appropriate manner as quickly and reliably as possible. Some effects of reversal therapy have been reported in small-scale observational studies. Discontinued antithrombotic drugs should be resumed in the neurotrauma subacute phase. Resuming antithrombotic drugs reduces the risk of ischemic complications, but increases the risk of bleeding complications. To summarize, the benefits of resuming antithrombotic drugs have been reported, and it is recommended that antithrombotic drugs be resumed 3-10 days after injury.


Assuntos
Lesões Encefálicas Traumáticas , Preparações Farmacêuticas , Idoso , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/tratamento farmacológico , Fibrinolíticos/efeitos adversos , Humanos , Japão
2.
No Shinkei Geka ; 49(5): 1093-1104, 2021 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-34615769

RESUMO

Although surgical site infections(SSIs)are usually controllable, their occasional occurrence is unavoidable. SSIs in neurosurgery comprise surgical-wound infections and surgical-organ/space infections. Data from the Japan Nosocomial Infections Surveillance revealed an overall infection rate of 1.1% during the first half of 2020. Responses to two questionnaire-based surveys on SSI prevention and complications related to cranial implant/artificial bone revealed the real world situation in neurosurgery. In 2020, neurosurgical information was added to the practical guidelines concerning the proper use of prophylactic antibacterial drug for SSIs. COVID-19 hygiene control protocols may have reduced the incidence of SSIs. It may be prudent to continue this stringent hygiene control after the COVID-19 pandemic has abated. Information of medical material on SSI is presented in this article, including the Plus suture®, DuraGen®, DuraSeal®, Adherus®, ultra-high-molecular-weight polyethylene(SKULPIO®, CRANIOFIT-PE®), Bioglide® and Bactiseal® shunt systems, and olanexidine. Minimizing SSIs requires proper knowledge on infection control, taking care while performing neurosurgical procedures, and compassion for the patients. In addition, information and material must be updated over time.


Assuntos
COVID-19 , Neurocirurgia , Humanos , Procedimentos Neurocirúrgicos/efeitos adversos , Pandemias , SARS-CoV-2 , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle
3.
World J Gastroenterol ; 27(36): 5989-6003, 2021 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-34629815

RESUMO

Laparoscopic cholecystectomy (LC) is one of the most frequently performed gastrointestinal surgeries worldwide. Bile duct injury (BDI) represents the most serious complication of LC, with an incidence of 0.3%-0.7%, resulting in significant perioperative morbidity and mortality, impaired quality of life, and high rates of subsequent medico-legal litigation. In most cases, the primary cause of BDI is the misinterpretation of biliary anatomy, leading to unexpected biliary lesions. Near-infrared fluorescent cholangiography is widely spreading in clinical practice to delineate biliary anatomy during LC in elective and emergency settings. The primary aim of this article was to perform an up-to-date overview of the evolution of this method 12 years after the first clinical application in 2009 and to highlight all advantages and current limitations according to the available scientific evidence.


Assuntos
Doenças dos Ductos Biliares , Colecistectomia Laparoscópica , Colangiografia , Colecistectomia Laparoscópica/efeitos adversos , Corantes , Humanos , Qualidade de Vida
4.
World J Gastroenterol ; 27(36): 6053-6063, 2021 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-34629819

RESUMO

Hepatitis B virus (HBV) infection is one of the main causes of morbidity and mortality worldwide. Most children acquire the infection perinatally or during early childhood and develop a chronic hepatitis characterized by a high viral replication and a low-inflammation phase of infection, with normal or only slightly raised aminotransferases. Although a conservative approach in children is usually recommended, different therapies exist and different therapeutic approaches are possible. The main goals of antiviral treatment for children with chronic HBV infection are to suppress viral replication and to warn the disease progression to cirrhosis and hepatocellular carcinoma, although these complications are rare in children. Both United States Food and Drug Administration (US-FDA) and European Medicines Agency (EMA) have approved interferon alfa-2b for children aged 1 year and older, pegylated interferon alfa-2a and lamivudine for children aged 3 years and older, entecavir for use in children aged 2 years and older, and adefovir for use in those 12 years of age and older. Tenofovir disoproxil fumarate is approved by EMA for children aged 2 years and older and by US-FDA for treatment in children aged 12 years and older. Finally, EMA has approved the use of tenofovir alafenamide for treatment of children aged 12 years and older or for children weighing more than 35 kg independent of age. This narrative review will provide the framework for summarizing indications to antiviral therapy in the management of chronic HBV infection in children and adolescents.


Assuntos
Hepatite B Crônica , Hepatite B , Neoplasias Hepáticas , Adolescente , Antivirais/efeitos adversos , Criança , Pré-Escolar , Hepatite B/tratamento farmacológico , Vírus da Hepatite B/genética , Hepatite B Crônica/diagnóstico , Hepatite B Crônica/tratamento farmacológico , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Estados Unidos/epidemiologia
5.
Medicine (Baltimore) ; 100(39): e27323, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34596133

RESUMO

BACKGROUND: Mild cognitive impairment (MCI), as a common neurodegenerative aging disease representing an intermediate stage between normal cognitive functioning and dementia, poses an excessive burden on health care. The clinical benefit of Chinese herbal medicines (CHMs) for MCI remains inconclusive. This study is aimed at evaluating the efficacy and acceptability of CHMs through meta-analysis and trial sequential analysis (TSA). METHODS: We applied extensive strategies on preliminary literature screening to identify relevant randomized controlled trials which meticulously compare any of CHMs interventions with placebo groups as monotherapy for MCI. The primary outcome of this study is the change of global cognitive function, and the secondary outcomes include assessments of activities of daily living, mood, and adverse events. Data synthesis, risk of bias assessment, sensitivity and subgroup analyses, and TSA will be conducted with application of Review Manager, Stata, and TSA software. The quality of the evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation instrument. INPLASY registration number: INPLASY202190006 (https://inplasy.com/inplasy-2021-9-0006/). RESULTS: This study will confirm the clinical efficacy and safety of CHMs when used in the treatment of patients with MCI. CONCLUSION: This study will provide reliable evidence and references for the selection of CHMs in therapy and future clinical research of MCI.


Assuntos
Disfunção Cognitiva/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Atividades Cotidianas , Afeto/efeitos dos fármacos , China , Medicamentos de Ervas Chinesas/administração & dosagem , Medicamentos de Ervas Chinesas/efeitos adversos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
6.
Pan Afr Med J ; 39: 208, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34603589

RESUMO

Acinetobacter ursingii is an anaerobic gram negative opportunistic coccobacillus, rarely isolated in bacteremic patients. It is mainly found in immunocompromised and severely ill patients with no identifiable source of infection. When isolated into the bloodstream, it usually displays resistance to at least two antimicrobial agents. To date only seven cases of bacteremia due to this microorganism have been reported in adults, of which, this accounts for the second one associated to renal replacement therapy and the first case of a documented catheter-related bloodstream infection (CRBSI) in a patient with a hemodialysis catheter. A 78-year-old male presented into the emergency department with acute kidney injury requiring hemodialysis, later developing bacteremia due to Acinetobacter ursingii.


Assuntos
Infecções por Acinetobacter/diagnóstico , Acinetobacter/isolamento & purificação , Bacteriemia/diagnóstico , Infecções Relacionadas a Cateter/diagnóstico , Infecções por Acinetobacter/microbiologia , Injúria Renal Aguda/terapia , Idoso , Bacteriemia/microbiologia , Infecções Relacionadas a Cateter/microbiologia , Humanos , Masculino , Diálise Renal/efeitos adversos , Diálise Renal/métodos
7.
Artigo em Inglês | MEDLINE | ID: mdl-34620621

RESUMO

INTRODUCTION: Here we report the glycemic efficacy and safety of ertugliflozin in patients in the VERTIS CV cardiovascular outcome trial with chronic kidney disease (CKD) stage 3. RESEARCH DESIGN AND METHODS: Prespecified and post-hoc analyses were performed in patients with an estimated glomerular filtration rate (eGFR) 30-<60 mL/min/1.73 m2 at screening. The primary endpoint was glycemic efficacy at week 18. Longer term glycemic efficacy and changes in body weight, systolic blood pressure (SBP), and eGFR were also evaluated. RESULTS: Among 8246 patients in VERTIS CV, 1776 patients had CKD stage 3; 1319 patients had CKD stage 3A (eGFR 45-<60 mL/min/1.73 m2); 457 patients had CKD stage 3B (eGFR 30-<45 mL/min/1.73 m2). Week 18 least squares (LS)-mean (95% CI) placebo-adjusted changes from baseline in glycated hemoglobin (HbA1c) for 5 mg and 15 mg ertugliflozin were -0.27% (-0.37% to -0.17%) and -0.28% (-0.38% to -0.17%), respectively, for CKD stage 3 overall and -0.27% (-0.38% to -0.15%) and -0.31% (-0.43% to -0.19%), respectively, for CKD stage 3A (all p<0.001). For CKD stage 3B, the reduction in HbA1c for 5 mg ertugliflozin was -0.28% (-0.47% to -0.08%) (p=0.006) and for 15 mg ertugliflozin was -0.19% (-0.39% to 0.01%) (p=0.064). LS-mean placebo-adjusted reductions in body weight (range: -1.32 to -1.95 kg) and SBP (range: -2.42 to -3.41 mm Hg) were observed across CKD stage 3 categories with ertugliflozin. After an initial dip, eGFR remained above or near baseline with ertugliflozin treatment. The incidence of overall adverse events (AEs), symptomatic hypoglycemia, hypovolemia, and kidney-related AEs did not differ between ertugliflozin and placebo across CKD stage 3 subgroups. CONCLUSIONS: In VERTIS CV patients with CKD stage 3A, ertugliflozin resulted in reductions in HbA1c, body weight and SBP, maintenance of eGFR, and was generally well tolerated. Results in the CKD stage 3B subgroup were generally similar except for an attenuated HbA1c response with the 15 mg dose. TRIAL REGISTRATION NUMBER: NCT01986881.


Assuntos
Diabetes Mellitus Tipo 2 , Insuficiência Renal Crônica , Inibidores do Transportador 2 de Sódio-Glicose , Compostos Bicíclicos Heterocíclicos com Pontes , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Humanos , Hipoglicemiantes , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/tratamento farmacológico , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Resultado do Tratamento
8.
Environ Monit Assess ; 193(11): 708, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34623541

RESUMO

Air pollution is associated with several severe physical, behavioral, and psychological health risks and glitches. Air pollution has been linked to 11 million premature deaths in Pakistan, out of the total 153 million premature deaths worldwide. Air pollution is continuously growing as a threatening challenge for Pakistan. Keeping this in view, the current study was designed to assess air pollution in terms of air quality index (AQI), particulate matters (PM2.5 and PM10), SO2, NO2, and O3 over six districts of Malakand division, Northern Pakistan. The second part of the study appraised the associated self-reported effects of air pollution on Pakistani students and the practices, perceptions, and awareness of the students regarding air pollution through a closed-ended questionnaire, administered to 4100 students. The first section of the questionnaire was focused on the physical effects associated with air pollution; the second section was focused on air pollution-linked behavior and psychology; the third portion was focused on perception and awareness of the subjects, whereas the final section was focused on practices and concerns of the subjects regarding air pollution. The students reported that exposure to air pollution significantly affected their physical health, behavior, and psychology. The subjects were aware of the different air pollutants and health complications associated with air pollution, and therefore had adopted preventive measures. It was concluded that air pollution had adverse impacts on the physical and psychological health of the respondents, which consequently altered their behavior. Mass awareness, proper mitigating plan, suitable management, and implementation of strict environmental laws are suggested before the air gets further polluted and becomes life-threatening.


Assuntos
Poluição do Ar , Monitoramento Ambiental , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Humanos , Paquistão , Autorrelato , Estudantes
9.
Artigo em Chinês | MEDLINE | ID: mdl-34624944

RESUMO

Objective: To study the correlation between occupational radiation exposure and chronic metabolic diseases. Methods: The status of chronic metabolic diseases of medical workers were compared in 5 hospitals in Hangzhou. As representatives of chronic metabolic diseases, diabetes and metabolic syndrome (MS) were compared in association with duration of radiation exposure. Results: Long-term ionizing radiation (IR) exposure was led to increased blood pressure, fasting blood glucose (FBG) , dyslipidemia, gallbladder disease, and MS. The years of radiation exposure was associated with lens opacity, gallstone and MS in men and gallbladder polyps in women. Radiation working more than 10 years is one of the independent risk factors for increased FBG and MS. Moreover, the risk of FBG increase in the group of radiation working more than 10 years was 3.052 times of that the non-exposed group, and the risk of MS occurrence was 4.132 times that of the non-exposed group. Conclusion: Long-term exposure to IR increases the risk of chronic metabolic diseases.


Assuntos
Catarata , Exposição Ocupacional , Traumatismos Ocupacionais , Exposição à Radiação , Lesões por Radiação , Feminino , Humanos , Masculino , Exposição à Radiação/efeitos adversos
11.
Artigo em Chinês | MEDLINE | ID: mdl-34624959

RESUMO

With the continuous innovation of technology, genomics and other omics techniques, such as transcriptomics, proteomics, and metabolomics, are increasingly becoming an important basis for precision medicine. Current research on susceptibility to occupational noise hearing loss (ONHL) has focused on genomics. Building the future of precision medicine is the focus of current ONHL research. Compared to single-omics studies, the use of multi-omics analysis can provide an integrated flow of information on ONHL susceptibility. This paper outlines the advantages and limitations of different histological techniques and the application of each histology in the disease, and focuses on the feasibility of applying multi-omics techniques in ONHL susceptibility research. The analysis of multi-omics techniques can better guide the comprehensive understanding of the disease in clinical research.


Assuntos
Perda Auditiva , Ruído Ocupacional , Genômica , Humanos , Metabolômica , Ruído Ocupacional/efeitos adversos , Proteômica
12.
J Headache Pain ; 22(1): 121, 2021 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-34625019

RESUMO

BACKGROUND: Calcitonin gene-related peptide (CGRP) is expressed throughout the body and is a known mediator of migraine, exerting this biological effect through activation of trigeminovascular, meningeal and associated neuronal pathways located in close proximity to the central nervous system. Monoclonal antibodies (mAb) targeting the CGRP pathway are an effective new preventive treatment for migraine, with a generally favourable adverse event profile. Pre-clinical evidence supports an anti-inflammatory/immunoregulatory role for CGRP in other organ systems, and therefore inhibition of the normal action of this peptide may promote a pro-inflammatory response. CASES: We present a case series of eight patients with new or significantly worsened inflammatory pathology in close temporal association with the commencement of CGRP mAb therapy. CONCLUSION: This case series provides novel insights on the potential molecular mechanisms and side-effects of CGRP antagonism in migraine and supports clinical vigilance in patient care going forward.


Assuntos
Peptídeo Relacionado com Gene de Calcitonina , Transtornos de Enxaqueca , Anticorpos Monoclonais/efeitos adversos , Calcitonina , Sistema Nervoso Central , Humanos , Transtornos de Enxaqueca/tratamento farmacológico
13.
BMC Musculoskelet Disord ; 22(1): 859, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34625077

RESUMO

BACKGROUND: The use of Oxford uni-compartmental knee arthroplasty (UKA) has rapidly increased worldwide,however,the relevance of younger patients for postoperative function after Oxford UKA remains unclear. The main purpose of our study is to clarify the effectivemess of Oxford UKA in the younger Chinese patients with anteromedial osteoarthritis (AMOA). METHODS: We retrospectively enrolled 252 consecutive patients who underwent Oxford UKA for AMOA with a minimum follow-up of 5 years between March 2013 and December 2016. The patients were divided into the younger (≤60 years) and elderly (> 60 years) age groups. The demographic data and surgery variables were recorded and compared. Patient satisfaction grade, range of motion (ROM), Oxford knee score (OKS), Hospital for Special Surgery (HSS) score, Western Ontario and McMaster (WOMAC) Universities Osteoarthritis Index score and postoperative complications were recorded. The 5-year survival of the implants were also compared with TKA revision as the endpoint. RESULTS: A total of 252 consecutive patients were recruited, including 96 aged 60 years or less and 156 aged over 60 years. The mean follow-up duration in the younger and elderly groups were 73.6 months (SD,standard deviation, 4.1) and 74.7 months (SD 6.2) respectively. Patient satisfaction rate was high in both groups (P = 0.805). Furthermore, no significant differences were observed in postoperative ROM(P = 0.299), OKS(P = 0.117), HSS(P = 0.357) and WOMAC scores(P = 0.151) between the younger and elderly groups (P>0.05). However, the incidence of joint stiffness (P = 0.033) and delayed wound dehiscence (P = 0.026) were significantly different between both groups. Five-year implant survival without revision were also similar in both groups (96.9% vs 97.4%, P = 0.871), and that for the entire cohort was 97.2% (95% CI 95.4-99.6). CONCLUSION: Oxford UKA for AMOA demonstrated favorable results in younger patients aged ≤60 years at a minimum 5-year follow-up in terms of patient satisfaction, functional outcomes, implant survival and postoperative complications. Therefore, younger patients might not be considered as an absolute contraindication to Oxford UKA.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Idoso , Artroplastia do Joelho/efeitos adversos , Seguimentos , Humanos , Osteoartrite do Joelho/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
14.
BMC Musculoskelet Disord ; 22(1): 858, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34625082

RESUMO

INTRODUCTION: Total hip arthroplasty (THA) is generally considered to be one of the most successful orthopedic surgical procedures. However, no research has been conducted on the postoperative mental health of patients who underwent different approaches of THA. This paper seeks to compare the differences among three THA approaches: the normal lateral approach (NLA), the direct anterior approach (DAA) and the orthopädische chirurgie münchen (OCM) regarding their influence on patients' postoperative anxiety and depression. METHOD: A total of 95 THA patients were recruited for this study. All patients' preoperative information including results of Harris, SF-36 and Visual Analogue Scale (VAS) was carefully evaluated. Surgery-related data as well as five-day postoperative data were also collected. Three months after the surgery, a telephone follow-up was conducted to further evaluate patients' HADS and SF-36 results. RESULT: In the three-month postoperative evaluation of anxiety and depression, the NLA group scored significantly higher than both the DAA group and the OCM group, which was found relevant to the patient's incision length and five-day postoperative VAS results. A correlation between anxiety scores and the days of postoperative hospitalization was also noticed. Further analysis of patients' psychological state based on the SF-36 results revealed considerable differences in viability (VT) and social function (SF) between the NLA group and the OCM group. Other surgery-related data and postoperative data all demonstrated better results of the DAA group and the OCM group compared to the NLA group. CONCLUSION: Among the three different surgical approaches of THA, DAA and OCM compared with NLA are found to ease patients' postoperative anxiety and depression. LEVEL OF EVIDENCE: III.


Assuntos
Artroplastia de Quadril , Antivirais , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Ansiedade/etiologia , Artroplastia de Quadril/efeitos adversos , Depressão/diagnóstico , Depressão/epidemiologia , Depressão/etiologia , Humanos , Período Pós-Operatório
15.
J Med Case Rep ; 15(1): 506, 2021 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-34625100

RESUMO

BACKGROUND: Cesarean scar pregnancy is a complicated and potentially life-threatening type of ectopic pregnancy. This study reports two women with cesarean scar pregnancy who were successfully treated with systemic methotrexate administration, and two other women who needed local re-administration of methotrexate after systemic injection. CASE PRESENTATION: Four Iranian pregnant women aged 29-34 years who were between 5  to 7 gestational weeks with cesarean scar pregnancy diagnosis are described. After a single dose of systemic methotrexate injection, the level of serum beta-human chorionic gonadotropin decreased in two of the women, while fetal activity was observed in the other two women. In the latter patients, methotrexate was injected under transvaginal ultrasound guidance into the gestational sac. As a result, the serum beta-human chorionic gonadotropin level first increased and then decreased in these patients. During the follow-up period, all the patients were stable and no complications were observed. Serum beta-human chorionic gonadotropin levels reached the non-pregnancy range from 4 to 9 weeks after treatment. CONCLUSION: When diagnosed at early gestation, cesarean scar pregnancy can be treated successfully with methotrexate administration alone. The clinicians should be aware that the beta-human chorionic gonadotropin level may initially increase after methotrexate injection in some patients. However, the final outcome will be promising if the patients remain stable.


Assuntos
Abortivos não Esteroides , Gravidez Ectópica , Cesárea/efeitos adversos , Cicatriz/tratamento farmacológico , Cicatriz/patologia , Feminino , Humanos , Irã (Geográfico) , Gravidez , Gravidez Ectópica/diagnóstico por imagem , Gravidez Ectópica/tratamento farmacológico , Gravidez Ectópica/etiologia
16.
BMJ Case Rep ; 14(10)2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34625443

RESUMO

A 50-year-old Indian woman presented with acute dysphasia, left upper limb numbness and thrombocytopenia 12 days after receiving the ChAdOx1 nCoV-19 vaccine (AstraZeneca/Vaxzevria). MRI of the brain was unremarkable. Microangiopathic haemolytic anaemia with thrombocytopenia was noted on her peripheral blood film. A diagnosis of thrombotic thrombocytopenic purpura (TTP) was confirmed through the findings of absent ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) activity and markedly raised titre of ADAMTS13 autoantibodies. Prompt treatment with plasma exchange, adjunctive steroids and rituximab was commenced. A remission of TTP was achieved and she was discharged 3 weeks after admission. While other immune-mediated conditions have been documented after receipt of the vaccine, this report highlights the first case of immune-mediated TTP diagnosed after administration of the ChAdOx1 nCoV-19 vaccine.


Assuntos
Púrpura Trombocitopênica Trombótica , Vacinas , Vacinas contra COVID-19 , Feminino , Humanos , Pessoa de Meia-Idade , Troca Plasmática , Púrpura Trombocitopênica Trombótica/induzido quimicamente , Púrpura Trombocitopênica Trombótica/diagnóstico , Púrpura Trombocitopênica Trombótica/tratamento farmacológico , Rituximab/efeitos adversos
17.
BMJ Case Rep ; 14(10)2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34625447

RESUMO

The global COVID-19 pandemic remains challenging with efforts for community vaccination the primary strategy to control transmission and disease sequalae in the mid to long term. While several candidate vaccines have been approved for use, there is an ongoing discussion regarding potential vaccine-related adverse events. Notably, thrombotic thrombocytopaenia has been reported following ChAdOx1 nCov-19 (AstraZeneca) vaccination. We report the first known case of takotsubo (stress) cardiomyopathy 4 days after administration of the ChAdOx1 nCoV-19 vaccine in a 72-year-old man. While this condition remains one primarily seen in females, our case represents a new trigger that warrants careful consideration when assessing patients presenting with acute coronary syndromes following ChAdOx1 nCoV-19 vaccination.


Assuntos
COVID-19 , Cardiomiopatias , Idoso , Vacinas contra COVID-19 , Feminino , Humanos , Masculino , Pandemias , SARS-CoV-2 , Vacinação/efeitos adversos
18.
Clin Ter ; 172(5): 423-424, 2021 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-34625772

RESUMO

Abstract: The dual nature and the double use of γ-hydroxybutyric acid (GHB) are the fundamentals of its spread as recreational drug. Endo-genously, GHB acts as inhibitory neurotransmitter while exogenously it is administered in the form of sodium oxybate to treat cataplexy and to menage alcohol withdrawal. Illicit GHB is extensively used along with prescribed drugs and drugs of abuse for its euphoric and anabolic effects. Since it has been used as incapacitating agent to perpetrate rapes and commit robberies, GHB represents a social and public health issues. The tight window of detectability in biological matrices and the difficultly to read symptoms of polydrug overdose represent the modern challenges in forensic and clinical toxicology.


Assuntos
Drogas Ilícitas , Oxibato de Sódio , Síndrome de Abstinência a Substâncias , Humanos , Hidroxibutiratos , Oxibato de Sódio/efeitos adversos
19.
BMC Musculoskelet Disord ; 22(1): 860, 2021 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-34627205

RESUMO

BACKGROUND: To study the impact of valvular heart disease (VHD) on hip replacement, particularly the clinical impactions of aortic stenosis before total/partial hip arthroplasty. METHODS: This was a retrospective cohort study. Data on patients who had undergone hip replacement from 2005 to 2014 were extracted from the NIS database. Independent t test and chi-square test were used to analyze the essential characteristics of patients. Multivariate regression was used to estimate the correlation among demographics, comorbidities, complications, hospitalization costs, and time. RESULTS: VHD accounted for 5.56% and AS accounted for 0.03% of the patients before hip replacement surgeries. Patients with VHD before hip replacement are related to the following characteristics: female patients (odds ratio [OR] = 1.15 [1.12-1.18]), elective admission (OR = 0.78 [0.76-0.80]), Charlson Comorbidity Index ≥3 (OR = 1.06 [1.03-1.08]), large-volume hospitals (OR = 1.13 [1.1-1.2]), teaching hospitals (OR = 5 4.4 [2.9-6.7]), and hospital location in urban areas (OR = 1.22 [1.2-1.3]). In addition, VHD is a risk factor for mortality and some acute postoperative medical complications, such as acute cardiac event (OR = 2.96 [2.87-3.04]), acute pulmonary edema (OR = 1.13 [1.06-1.21]), acute cerebrovascular event (OR = 1.22 [1.16-1.74]), and acute renal failure (OR = 1.22 [1.17-1.27]). It also has an impact on DVT/PE (OR = 0.89 [0.8-0.99]). Patients with AS before hip replacement have basic demographic characteristics like those of hip replacement patients with valvular disease. Patients with AS are older than those without AS before surgery (OR = 3.28 [2.27-4.75) and are related to the following characteristics: female patients (OR = 1.92 [1.32-2.8]) and elective admission (OR = 0.51 [0.36-0.75]). The perioperative period is limited to acute postoperative complications, such as acute cardiac events (OR = 2.50 [1.76-3.53]) and acute hepatic failure (OR = 7.69 [1.8-32.89]). Both valvular diseases and AS are associated with a higher mortality rate and hospitalization cost. CONCLUSION: VHD independently predicted mortality rate and surgical and medical complications after total/partial hip arthroplasty.


Assuntos
Artroplastia de Quadril , Doenças das Valvas Cardíacas , Artroplastia de Quadril/efeitos adversos , Bases de Dados Factuais , Feminino , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/cirurgia , Humanos , Pacientes Internados , Estudos Retrospectivos
20.
BMC Musculoskelet Disord ; 22(1): 863, 2021 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-34627214

RESUMO

BACKGROUND: To determine the relationship between clusters of back pain and joint pain and prescription opioid dispensing. METHODS: Of 11,221 middle-aged participants from the Australian Longitudinal Study of Women's Health, clusters of back pain and joint pain from 2001 to 2013 were identified using group-based trajectory modelling. Prescription opioid dispensing from 2003 to 2015 was identified by linking the cohort to Pharmaceutical Benefit Scheme dispensing data. Multinomial logistic regression was used to examine the association between back pain and joint pain clusters and dispensing of prescription opioids. The proportion of opioids dispensed in the population attributable to back and join pain was calculated. RESULTS: Over 12 years, 68.5 and 72.0% women reported frequent or persistent back pain and joint pain, respectively. There were three clusters ('none or infrequent', 'frequent' and 'persistent') for both back pain and joint pain. Those in the persistent back pain cluster had a 6.33 (95%CI 4.38-9.16) times increased risk of having > 50 opioid prescriptions and those in persistent joint pain cluster had a 6.19 (95%CI 4.18-9.16) times increased risk of having > 50 opioid prescriptions. Frequent and persistent back and joint pain clusters together explained 41.7% (95%CI 34.9-47.8%) of prescription opioid dispensing. Women in the frequent and persistent back pain and joint pain clusters were less educated and reported more depression and physical inactivity. CONCLUSION: Back pain and joint pain are major contributors to opioid prescription dispensing in community-based middle-aged women. Additional approaches to reduce opioid use, targeted at those with frequent and persistent back pain and joint pain, will be important in order to reduce the use of opioids and their consequent harm in this population.


Assuntos
Analgésicos Opioides , Artralgia , Analgésicos Opioides/efeitos adversos , Artralgia/diagnóstico , Artralgia/tratamento farmacológico , Artralgia/epidemiologia , Austrália/epidemiologia , Dor nas Costas/diagnóstico , Dor nas Costas/tratamento farmacológico , Dor nas Costas/epidemiologia , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...