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Introducción: Un elevado porcentaje de pacientes que han padecido la covid-19 refiere una serie de manifestaciones clínicas que persisten luego del cuadro original. Uno de los grupos poblacionales en el que esto ocurre con mayor frecuencia es el de adultos mayores, a los cuales se les debe prestar máxima atención. Objetivo: Evaluar la efectividad de la terapia multimodal en ancianos con manifestaciones psicosomáticas por síndrome poscovid-19. Métodos: Se realizó un estudio cuasiexperimental de intervención terapéutica, sin grupo de control, en el Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, durante el periodo de marzo a mayo de 2021. La población estudiada se conformó por 25 pacientes de 60 y más años de edad con síndrome poscovid-19, quienes presentaron manifestaciones psicosomáticas y recibieron tratamiento multimodal (psicoterapia grupal y terapia floral). Se analizaron las variables sexo, edad, manifestaciones psicosomáticas y respuesta al tratamiento, cuya efectividad se evaluó según la proporción de pacientes con respuesta satisfactoria, considerando un nivel de significación de 5 %. Resultados: Predominaron el sexo masculino y los grupos etarios de 65-69 y 70-74 años. Las manifestaciones más frecuentes fueron la disnea, la astenia y la ansiedad. Después de aplicar la terapia multimodal, se logró una proporción significativa de pacientes con condición favorable, pues disminuyó el número de manifestaciones psicosomáticas. Conclusiones: La terapia multimodal resultó ser efectiva para reducir el número de manifestaciones psicosomáticas en los adultos mayores con síndrome poscovid-19.
Introduction: A high percentage of patients that have suffered from covid-19 refer a series of clinical manifestations that persist after the original pattern. One of the population groups in which this happens most frequently is the elderly, to whom maximum care should be paid. Objective: To evaluate the effectiveness of the combined modality therapy in elderly with psychosomatic manifestations due to postcovid-19 syndrome. Methods: A quasi-experiment study without control group of therapeutic intervention was carried out at Dr. Juan Bruno Zayas Alfonso General Teaching Hospital in Santiago de Cuba, from March to May, 2021. The population studied was made up of 25 patients of 60 years and over with postcovid-19 syndrome, who presented psychosomatic manifestations and received combined modality treatment (group psychotherapy and floral therapy). Sex, age and psychosomatic manifestations were analyzed as variables, as well as the response to treatment, which effectiveness was evaluated according to the proportion of patients with a satisfactory response, taking into account a significance level of 5 %. Results: There was a prevalence of the male sex and the 65-69 and 70-74 age groups. The most frequent manifestations were dyspnea, asthenia and anxiety. After applying the combined modality therapy, a significant proportion of patients with a favorable condition was achieved, since the number of psychosomatic manifestations decreased. Conclusions: Combined modality therapy was effective to reduce the number of psychosomatic manifestations in elderly with postcovid-19 syndrome.
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ABSTRACT BACKGROUND AND OBJECTIVES: Spine diseases have a high annual prevalence and are the main causes of years lived with disability and chronic pain. Among the postoperative analgesic control options, patient-controlled analgesia (PCA) and multimodal analgesia (MMA) have shown good clinical results. This meta-analysis seeks new evidence to help in the treatment of acute postoperative pain in patients undergoing spinal surgery. CONTENTS: The following databases were used: Cochrane Central Register of Controlled Trials, Medline and Embase. Studies that compared two post-surgical analgesic interventions were included; MMA and PCA. The parameters evaluated were: analgesic effect; opioid consumption; length of hospital stay; and adverse effects. Registration of the systematic review protocol: (PROSPERO CRD42023446627). There was no statistical difference when assessing analgesic improvement comparing MMA to PCA (MD -0.12 [-0.41, 0.17] 95%CI with p=0.69). There was a statistical difference, with lower opioid consumption in MMA compared to PCA (MD -3.04 [-3.69, -2.39] 95%CI with p=0.0002). Statistically significant difference regarding length of hospital stay in favor of MMA (MD -13.17 [-16.98, -9.36] 95%CI with p=0.00001), and significantly lower incidence of nausea and vomiting in patients undergoing MMA in compared to PCA (OR 0.26 [0.11, -0.64] 95%CI with p=0.003). CONCLUSION: MMA was equivalent to PCA in the treatment of acute postoperative spinal pain, with the significant clinical advantage and safety of lower amounts of infused opioids, shorter hospital stay and lower incidence of adverse effects.
RESUMO JUSTIFICATIVA E OBJETIVOS: As doenças da coluna apresentam alta prevalência anual e são as principais causas de anos vividos com incapacidade e de cronificação da dor. Dentre as opções de controle analgésico pós-operatória, a analgesia controlada pelo paciente (ACP) e a analgesia multimodal (AMM) apresentam bons resultados clínicos. O objetivo deste estudo foi buscar novas evidências que auxiliem no tratamento da dor aguda no pós-operatório do paciente submetido à cirurgia da coluna. CONTEÚDO: As bases de dados utilizadas: Cochrane Central Register of Controlled Trials, Medline e Embase. Foram incluídos estudos que compararam duas intervenções analgésicas pós-cirúrgicas; AMM e ACP. Os parâmetros avaliados foram: efeito analgésico; consumo de opioide; tempo de internação hospitalar e efeitos adversos. Registro do protocolo de revisão sistemática: (PROSPERO CRD42023446627). Não houve diferença estatística quando avaliadas a melhora analgésica comparando a AMM à ACP (MD -0,12 [-0,41, 0,17] 95%CI com p=0,69). Houve diferença estatística, com menor consumo de opioide na AMM em comparação à ACP (MD -3,04 [-3,69, -2,39] 95%IC com p=0,0002). Diferença estatística significativa com relação ao tempo de permanência hospitalar a favor da AMM (MD -13,17 [-16,98, -9,36] 95%IC com p=0,00001), e incidência significativamente menor de náuseas e vômitos nos pacientes submetidos a AMM em comparação a ACP (OR 0,26 [0,11, -0,64] 95%IC com p=0,003). CONCLUSÃO: A AMM foi equivalente à ACP no tratamento da dor aguda pós-operatória da coluna, com a significativa vantagem clínica e a segurança de menores quantidades de opioides infundidos, menor tempo de internação hospitalar e menor incidência de efeitos adversos.
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Objective:To investigate the characteristics of sleep disorders in patients with Alzheimer's disease and the intervention effect of integrated traditional Chinese and Western medicine.Methods:A total of 102 patients with Alzheimer's disease who had sleep disorders and received treatment at Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine were included in the observation group. A total of 102 patients who concurrently received physical examination in the same hospital were included in the control group. Clinical consultation was performed to analyze the types and characteristics of sleep disorders in patients with Alzheimer's disease. The included patients with Alzheimer's diseae were divided into group A and group B using the random number table method, with 51 patients per group. Group A received routine western medicine intervention, while group B received traditional Chinese medicine intervention and routine western medicine intervention. The types of sleep disorders were observed in patients with Alzheimer's disease and older adult patients who undergo physical examination. The changes in traditional Chinese medicine syndrome score and sleep quality were evaluated in groups A and B.Results:The incidence rates of screaming, difficulty in falling asleep, excessive daytime sleepiness, nocturnal restlessness, obstructive sleep apnea syndrome, and fragmented sleep in the observation group were 13.73% (14/102), 58.82% (60/102), 49.02% (50/102), 49.02% (50/102), 24.51% (25/102) and 98.04% (100/102), respectively, which were significantly higher than 1.96% (2/102), 23.53% (24/102), 17.65% (18/102), 4.90% (5/102), 5.88%(6/102) and 50.98% (52/102), respectively in the control group ( χ2 = 9.76, 26.22, 22.58, 50.40, 13.73, 59.46, all P < 0.05). After intervention, the scores of insomnia, dizziness and tinnitus, mental confusion, and forgetfulness in group B were 1.0 (0.00, 1.00) point, 0.00 (0.00, 1.00) point, 0.00 (0.00, 1.00) point, and 1.00 (1.00, 1.00) point, respectively, which were significantly lower than (1.00, 2.00) points, 1.00 (1.00, 2.00) points, 1.00 (0.00, 1.00) points, and 1.00 (1.00, 2.00) points in group A ( Z = -1.86, -2.13, -2.36, -2.00, all P < 0.05). After intervention, the Pittsburgh Sleep Quality Index score and the Modified Epworth Sleepiness Scale score in Group B were (7.56 ± 1.93) points and (13.02 ± 2.06) points, respectively, which were significantly lower than (10.87 ± 2.21) points and (16.44 ± 2.87) points in group A ( t = 8.05, 6.91, both P < 0.001). Conclusion:The main characteristics of sleep disorders in patients with Alzheimer's disease include screaming, difficulty in falling asleep, excessive daytime sleepiness, nocturnal restlessness, obstructive sleep apnea syndrome, and fragmented sleep. Combined traditional Chinese and western medicine can alleviate clinical symptoms and improve sleep quality in patients with Alzheimer's disease who have sleep disorders.
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Ankylosing spondylitis is an autoimmune disease with a high incidence rate in clinic. It is characterized by abnormal ossification and ankylosis of the spine and sacroiliac joints. With the further development of the disease, the quality of life of patients will eventually decline sharply. At present, there are many treatment methods that can be chosen, and early intervention and comprehensive treatment are key, including drug therapy, rehabilitation training, surgical treatment, etc. Although there are many treatment methods to choose from, its pathogenesis is not fully understood, and it is still a difficult point in clinical treatment. This article systematically reviews the literature on the treatment of ankylosing spondylitis in recent years, providing reference for further optimizing comprehensive treatment strategies.
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In recent years, the incidence of stroke patients in China is increasing, and the motor dysfunction caused by it often seriously affects the quality of daily life of the patients, Neuromuscular electrical stimulation (NMES), as an emerging rehabilitation therapy, is widely used in the treatment of motor dysfunction in stroke patients. This paper summarizes the parameters and mechanisms of the role of NMES in motor function rehabilitation after stroke and its use in clinical practice. In the future, the specific mechanism of NMES action and efficient and safe therapeutic options should be further explored.
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ABSTRACT BACKGROUND AND OBJECTIVES: Wound complications and pharmacological pain relief methods used at the skin surgical site after cesarean delivery may result in women's physical and emotional burden. Thus, nonpharmacological treatments must be explored to avoid these complications and side effects on maternal health. The objective of this study was to investigate the effects of Combined Ultrasound and Electric Field Stimulation (CUSEFS) on cicatricial pain and functional capacity in immediate cesarean delivery. METHODS: This study has a randomized clinical trial, double-blind, and placebo-controlled design. Thirty women (25.7±5.0 years) in immediate postpartum were randomly assigned to three groups: Control (CG, n:9), CUSEFS (TG, n:11), and Placebo (PG, n:10). CUSEFS was performed once for 20 minutes. Cicatricial pain (McGill Pain Questionnaire) and functional capacity (Functional Capacity Check) was assessed at baseline, after the intervention, and after 30 minutes. Cohen's (d) and Mixed-design analysis of variance were used to compare groups. RESULTS: Immediately after the intervention, TG showed a decrease in cicatricial pain compared with CG in sensory (d:3.8 to 4.0), affective (d:4.0), and total categories (d:3.9). In functional capacity, TG had less difficulty than CG at walking (d:0.6) and lying down (d:1.1), and PG at rest (d: 0.9). CONCLUSION: CUSEFS might be a resource for managing cicatricial pain and functional capacity in immediate cesarean delivery. Further studies with longer duration and different CUSEFS doses/parameters are required.
RESUMO JUSTIFICATIVA E OBJETIVOS: As complicações na ferida e o uso de métodos farmacológicos de alívio da dor no local cirúrgico após a cesariana podem resultar em sobrecarga física e emocional para a mulher. Assim, tratamentos não farmacológicos devem ser explorados para evitar essas complicações e efeitos adversos à saúde materna. O objetivo deste estudo foi investigar os efeitos da terapia combinada de estimulação elétrica por meio do ultrassom (CUSEFS) na dor cicatricial e na capacidade funcional no pós-parto imediato de cesariana. MÉTODOS: Este estudo possui um desenho de ensaio clínico randomizado, duplo-cego e controlado por placebo. Trinta mulheres (25,7±5,0 anos) em pós-parto imediato de cesariana foram distribuídas aleatoriamente em três grupos: Controle (CG, n:9), CUSEFS (TG:11) e Placebo (PG, n:10). O CUSEFS foi realizado uma vez por 20 minutos. A dor cicatricial (Questionário de Dor McGill) e a capacidade funcional (Functional Capacity Check) foram avaliadas no início, após a intervenção e após 30 minutos. As análises de variância de design misto e Cohen (d) foram usadas para comparar os grupos. RESULTADOS: Imediatamente após a intervenção, o TG apresentou diminuição na dor cicatricial em relação ao CG nas categorias sensorial (d:3,8 a 4,0), afetiva (d:4,0) e total (d:3,9). Na capacidade funcional, o TG apresentou menor dificuldade que o CG na marcha (d:0,6) e deitado (d:1,1), e que o PG em repouso (d:0,9). CONCLUSÃO: O CUSEFS pode ser um recurso para o manejo da dor cicatricial e da capacidade funcional imediatamente após a cesariana. Além disso, são necessários mais estudos com maior duração e diferentes doses/parâmetros de CUSEFS.
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RESUMEN La trombocitopenia inmune primaria es un trastorno autoinmune adquirido, caracterizado por una destrucción plaquetaria excesiva, derivada de la producción de anticuerpos contra la membrana plaquetaria, conllevando a un alto riesgo de hemorragia para el paciente. Actualmente, la piedra angular del tratamiento sigue siendo el uso de agentes de primera línea como los glucocorticoides y la inmunoglobulina intravenosa. Sin embargo, en algunos casos los pacientes pueden ser refractarios a estos, con el requerimiento de terapias de segunda y tercera línea. Se presenta el caso clinico de una paciente de 25 años con historia de trombocitopenia inmune primaria con presentación severa por la presencia de sangrado gastrointestinal y estado anémico asociado, con refractariedad a diferentes estrategias de tratamiento, incluida la esplenectomia, requiriendo posterior manejo combinado con Ri-tuximab, con el cual se logró mantener un recuento plaquetario adecuado. Consideramos que este caso toma interés clinico dado los escasos reportes de casos de esta condición y la limitada evidencia que se tiene ante las terapias secuenciales en pacientes refractarios a tratamiento de primera linea.
ABSTRACT Primary immune thrombocytopenia is an acquired autoimmune disorder, characterized by platelet destruction, resulting from the production of antibodies against the platelet membrane, involving ahigh risk of bleeding for the patient. Currently, the cornerstone of treatment is the use of first-line agents such glucocorticoids and intravenous immunoglobulin. However, in some patients may be refractory to these agents, requiring the use of second and third line agents. We present the case of a 25-year-old female patient with a history of primary immune thrombocytopenia with severe presentation due to the presence of gastrointestinal bleeding and associated anemic state, with refractoriness to different treatment including splenectomy and the subsequent use of Rituximab, which was used to maintain an adequate platelet count. We consider that this case is of clinical interest given the scarce case reports of this condition and the limited evidence on sequential therapies in patients refractory to first line treatment.
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Resumo Objetivo Analisar a aceitabilidade de pessoas submetidas ao cateterismo cardíaco não programado acerca de uma intervenção complexa (IC) de enfermagem para reduzir a ansiedade. Métodos Estudo qualitativo e avaliativo da aceitabilidade de 15 participantes submetidos ao cateterismo cardíaco acerca de uma IC de enfermagem. A coleta de dados foi realizada na unidade de emergência de um hospital de alta complexidade da cidade de São Paulo, especializado em cardiologia. Os participantes tinham diagnóstico de Síndrome Coronariana Aguda e receberam a IC, constituída por componente musical e educativo, denominada Education and Music Intervention to Reduce Anxiety (EMIRA). Os dados foram coletados no período de setembro a outubro de 2021, e os participantes foram submetidos à entrevista semiestruturada. As perguntas norteadoras da entrevista foram elaboradas com base em Kazdin. As entrevistas foram gravadas e transcritas para análise de conteúdo de Bardin. Para analisar a aceitabilidade dos participantes da EMIRA, utilizou-se o aporte teórico das Representações Cotidianas. Resultados A análise da aceitabilidade em relação à EMIRA permitiu a identificação de três categorias: Intervenção complexa EMIRA: nova experiência que ajuda a entender o cateterismo cardíaco; Intervenção complexa EMIRA: uma experiência que gera satisfação; e Intervenção complexa EMIRA: uma experiência que alivia a ansiedade. Os participantes relataram sensações de calma, alívio, tranquilidade, satisfação, e recomendaram o uso da EMIRA. Conclusão A experiência dos participantes com a EMIRA foi positiva, sugerindo boa aceitabilidade da IC por pessoas aguardando a realização do cateterismo não programado na unidade de emergência.
Resumen Objetivo Analizar la aceptabilidad de una intervención compleja (IC) de enfermería para reducir la ansiedad de personas sometidas a un cateterismo cardíaco no programado. Métodos Estudio cualitativo y evaluativo de aceptabilidad de una IC de enfermería en 15 participantes sometidos a un cateterismo cardíaco. La recopilación de datos se realizó en una unidad de emergencia de un hospital de alta complejidad de la ciudad de São Paulo, especializado en cardiología. Los participantes tenían diagnóstico de Síndrome Coronario Agudo y recibieron la IC, que tenía un componente musical y educativo, denominada Education and Music Intervention to Reduce Anxiety (EMIRA). Se recopilaron los datos en el período de septiembre a octubre de 2021, y los participantes respondieron una entrevista semiestructurada. Las preguntas orientadoras de la entrevista se elaboraron con base en Kazdin. Las entrevistas fueron grabadas y se transcribieron para el análisis de contenido de Bradin. Para analizar la aceptabilidad de los participantes de la EMIRA, se utilizó el aporte teórico de las representaciones cotidianas. Resultados El análisis de aceptabilidad de la intervención EMIRA permitió identificar tres categorías: Intervención compleja EMIRA: nueva experiencia que ayuda a entender el cateterismo cardíaco, Intervención compleja EMIRA: una experiencia que genera satisfacción e Intervención compleja EMIRA: una experiencia que calma la ansiedad. Los participantes relataron sensaciones de calma, alivio, tranquilidad y satisfacción, y recomendaron el uso de la EMIRA. Conclusión La experiencia de los participantes con la intervención EMIRA fue positiva, lo que sugiere una buena aceptabilidad de la IC por parte de personas que aguardan la realización de un cateterismo no programado en la unidad de emergencia.
Abstract Objective To analyze the acceptability of people undergoing unscheduled cardiac catheterization about a complex nursing intervention (CI) to reduce anxiety. Methods This is a qualitative and evaluative study of the acceptability of 15 participants who underwent cardiac catheterization regarding a nursing CI. Data collection was carried out in the emergency unit of a highly complex hospital in the city of São Paulo, specialized in cardiology. Participants had a diagnosis of Acute Coronary Syndrome and received the CI, consisting of a musical and educational component, called Education and Music Intervention to Reduce Anxiety (EMIRA). Data were collected from September to October 2021, and participants underwent a semi-structured interview. The guiding questions of the interview were elaborated based on Kazdin. The interviews were recorded and transcribed for Bardin's content analysis. To analyze EMIRA participants' participants, Representations of Everyday Life's theoretical contribution was used. Results Acceptability analysis in relation to EMIRA allowed identifying three categories: EMIRA complex intervention: new experience that helps to understand cardiac catheterization; Complex EMIRA intervention: an experience that generates satisfaction; and EMIRA complex intervention: an anxiety-relieving experience. Participants reported feelings of calm, relief, tranquility, satisfaction, and recommended using EMIRA. Conclusion Participants' experience with EMIRA was positive, suggesting good acceptability of CI by people awaiting unscheduled catheterization in the emergency unit.
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Objective:To investigate the clinicopathological characteristics and prognostic factors of pancreatic cancer patients with liver metastasis.Methods:The clinical data of 67 pancreatic cancer patients with liver metastases who received first treatment in Department of Oncology of the First Affiliated Hospital of Naval Medical University between July 2012 and June 2016 were retrospectively analyzed. The relationship between patient survival time and the clinicopathological characteristics including patients' age, gender, tumor location, physical activity status score, tumor markers, number of distant metastatic organs, radiotherapy at the primary site, first-line chemotherapy regimen, number of cycles of first-line chemotherapy received, and liver metastases undergoing transcatheter arterial chemoembolization (TACE) was analyzed. Kaplan-Meier curves were plotted to reveal survival time in pancreatic cancer patients with liver metastases, and univariate and multifactorial COX proportional risk regression models were used to analyze independent prognostic risk factors for pancreatic cancer patients with liver metastases.Results:All patients were followed up until December 31, 2018, and all 67 patients died. The results of univariate analysis showed that patients with positive tumor marker, number of distant metastatic organs ≥2, number of cycles of first-line chemotherapy ≤2, no radiotherapy to the primary site and no TACE had shorter survival than those with negative tumor marker, one distant metastatic organ, number of cycles of first-line chemotherapy ≥3, with radiotherapy to the primary site and TACE, and all the differences were statistically significant (all P values <0.05). The results of multifactorial analysis showed that positive tumor markers ( HR=0.567, 95% CI 0.332-0.954, P=0.031), number of distant metastatic organs ≥2 ( HR=0.581, 95% CI 0.353-0.977, P=0.039), number of first-line chemotherapy cycles ≤2( HR=1.890, 95% CI 1.155-3.121, P=0.013) and primary foci without radiotherapy ( HR=0.414, 95% CI 0.231-0.732, P=0.002) were the independent prognostic risk factors for pancreatic cancer patients with liver metastasis. Conclusions:The prognosis of pancreatic cancer patients with liver metastasis is affected by multiple factors, among which positive tumor markers, more distant metastatic organs, no radiotherapy at the primary site and fewer first-line chemotherapy cycles are independent prognostic risk factors for pancreatic cancer with liver metastasis.
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According to the International Agency for Research on Cancer (IARC) of the World Health Organization, the number of people with primary liver cancer is predicted to exceed 1 million per year by 2025, making it a major threat to human life and health. According to "Standardization for Diagnosis and Treatment of Hepatocellular Carcinoma (2022 edition) " issued by the National Health Commission of China, locoregional interventional therapy represented by ablation and transcatheter arterial chemoembolization (TACE) has become the main treatment for unresectable intermediate-advanced hepatocellular carcinoma (HCC), in which the indications for TACE include patients with stage Ⅰb to Ⅲb HCC. Locoregional interventional therapy has been proved to have a clear immune activation effect, and with the gradual promotion of immune checkpoint inhibitors in clinical trials and applications at home and abroad, the combination therapy of locoregional intervention and immune checkpoint inhibitors has shown a more effective objective response rate, slower progression time and longer survival, bringing new hope to patients with inoperable intermediate-advanced HCC.
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Posttraumatic stress disorder (PTSD), the most common mental illness after patients suffer physically or emotionally from traumatic events, can cause persistently strong, painful and terrible avoidance symptoms, emotional and cognitive changes, causing psychologically strong stimulation and heavy burden to patients and even leading to some extreme behavioral reactions. Traumatic brain injury (TBI) is an important factor in the occurrence of PTSD, both of which shares many similar pathological overlaps, and may coexist and interact with each other. The hippocampus and amygdala play a central role in the pathogenesis of PTSD, but the specific cellular and molecular and neural circuit mechanisms are still unclear. About two-thirds of the patients still meet the diagnostic criteria for PTSD after psychotherapy. However, the current treatment methods are complicated and not unified, and patients treated with medications may have adverse drug reactions, poor treatment outcomes and recurrence. Therefore, it is of great significance to further clarify the occurrence and development of PTSD in TBI patients. The authors reviewed the research progress of the pathogenesis and treatment of PTSD in TBI patients, so as to provide reference for the related research and treatment of PTSD in TBI patients.
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Objective:To investigate the curative effects of Beck's cognitive therapy (BCT) combined with transcranial magnetic stimulation (TMS) on post-stroke sleep disorders in patients.Methods:A total of 120 patients with post-stroke sleep disorders who were diagnosed and treated in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine between January and December 2020 were included in this study. They were randomly assigned to undergo TMS (TMS group), BCT (BCT group), or TMS plus BCT (combined group) ( n = 40/group). Before and after treatment, sleep quality and mental state scores were evaluated in each group. Results:After treatment, the Pittsburgh Sleep Quality Index (PSQI) score in the combined group [(5.68 ± 0.33) points] was significantly lower than that in the TMS group [(9.11 ± 0.83) points] and BCT group [(11.37 ± 1.06) points, F = 512.63, P < 0.001]. Sleep efficiency in the combined group [(56.73 ± 2.62)%] was significantly higher than that in the TMS group [(39.55 ± 3.02)%] and BCT group [(35.23 ± 1.41)%, F = 863.59, P < 0.001]. The Self-Rating Anxiety Scale (SAS) scores and Self-Rating Depression Scale (SDS) scores were significantly lower in the combined group compared with the TMS and BCT groups ( F = 412.52, 310.60, both P < 0.001). Conclusion:BCT combined with TMS can effectively improve sleep quality and reduce negative emotions in patients with post-stroke sleep disorders.
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Objective:To investigate the effects of educational level on smoking cessation in patients with moderate to severe tobacco dependence, explore effective individualized smoking cessation methods, and increase smoking cessation rate.Methods:A total of 480 patients with moderate to severe tobacco dependence who were willing to quit smoking and received treatment in the Department of Respiratory and Critical Care Medicine, Shengli Oilfield Central Hospital from January to December 2020 were included in this study. They were divided into four groups ( n = 120/group) according to their educational level: group A (elementary school and below), group B (junior high school and senior high school), group C (technical secondary school or college), and group D (university and above). All patients were randomly assigned to undergo "5A" intervention alone or "5A" intervention combined with varenicline intervention (combined intervention). Patients' awareness of the health risks of tobacco smoking was compared among the four groups. The smoking cessation rate measured at different time points was compared between different intervention strategies. Results:The scores of health risk of tobacco smoking in groups D, C, B, and A were (806.5 ± 35.7) points, (710.8 ± 26.2) points, (643.6 ± 43.4) points, and (512.4 ± 30.1) points, respectively. Patients with high education levels had high awareness of the health risk of tobacco smoking ( F = 1 543.26, P < 0.001). At 1, 3, and 6 months, the smoking cessation rate of combined intervention was higher than that of "5A" intervention alone in each group (group A: χ2 = 3.85, 4.23, 4.10, group B: χ2 = 4.30, 4.09, 4.60, group C: χ2 = 6.81, 4.30, 4.03, group D: χ2 = 6.71, 6.51, 4.73, all P < 0.05). The smoking cessation rate after 6 months of "5A" intervention alone or combined intervention in group D was 60.0% and 78.3% respectively, which were significantly higher than 41.7% and 60.0% in group C, 23.3% and 41.7% in group B, and 20.0% and 36.7% in group A ( χ2 = 26.59, 26.12, both P < 0.001). At different time points, the smoking cessation rates of the "5A" intervention alone in group D were significantly higher than those of combined intervention in groups A and B ( χ2 = 9.25, 25.04, 7.29, all P < 0.05). Conclusion:Awareness of the health risks of tobacco smoking is related to a patient's educational level, and affects smoking cessation. Individualized smoking cessation interventions based on a patient's educational level can increase the rate of smoking cessation.
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This article reported the comprehensive management of an extremely preterm infant with severe bronchopulmonary dysplasia. The patient born at 26 +6 gestational weeks was transferred to Children's Hospital of Fudan University due to invasive mechanical ventilation dependence at 61 d after birth and was diagnosed with severe bronchopulmonary dysplasia. A comprehensive treatment plan was adopted, including appropriate fluid restriction, improving nutrition, glucocorticoid administration, using antibiotics against Ureaplasma urealyticum infection to reduce pulmonary parenchymal lesions and alleviating pulmonary hypertension. The preterm infant was successfully extubated to non-invasive ventilation and subsequently weaned to a high-flow nasal cannula. Then, the patient was discharged at 372 d after birth (correct gestational age nine months and six days). At the 3-month follow-up after discharge, the patient remained on high-flow oxygen, but with lower flow and concentration of oxygen. Moreover, the growth, development and lung images were significantly improved. Follow-up to correct gestational age one year and 11 months, the child was not on oxygen any more, but on rehabilitation due to language and motor development retardation.
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Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-related death, and most patients with HCC are diagnosed at an advanced stage. Before 2017, tyrosine kinase inhibitors were the main drugs for the treatment of advanced hepatocellular carcinoma. With the emergence of immune checkpoint inhibitors (ICIs), immunotherapy has gradually brought new hope to such patients. At present, the combination of ICIs and other systemic or local treatments has become a potential strategy for the treatment of advanced hepatocellular carcinoma, and some of these combinations have been included in large-scale clinical trials. The main challenges of immunotherapy for advanced hepatocellular carcinoma include the exploration of predictive biomarkers, management of immune-related adverse events, and exploration of effective combination regimens. This article provides the latest research progress on the single or combined use of ICIs and other immunotherapy for hepatocellular carcinoma and discusses the limitations of current research and clinical application and the future development direction.
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The individuals with Hansen's disease experience situations of prejudice that, together with stigma and discrimination, culminate in social isolation and restrictions in social relationships. The aim of this study was to assess the perception of leprosy patients about their quality of life. This is a cross-sectional, quantitative study, whose convenience sample consisted of 94 leprosy patients, undergoing treatment, who attended health units in the city of Cuiabá, MT, Brazil. A structured questionnaire with sociodemographic data and information about the patient's knowledge about leprosy, prejudice, self-esteem and quality of life, was applied between April and August 2018.The results showed in the investigated population a predominance of males (55.3%), individuals with high school education (28.7%) and with an income ranging from 1 to 3 minimum wages (67%).The interviewees pointed out the side effects (44.7%) and the duration period (28.7%) as the greatest difficulty in the treatment. Most of the investigated (72.3%) had great knowledge about the disease, among which 26.6% had already suffered the leprosy reaction.40.4% of individuals were depressed and sad, and 69.1% had problems in employment after the diagnosis of the disease. When the quality of life was investigated, 45.7% of leprosy patients classified the domains evaluated between bad and very bad. Physical pain was associated with 43.7% of the individuals being unable to perform daily tasks. It can be concluded that leprosy causes suffering beyond pain and discomfort, with great social and psychological impact. (AU)
Os pacientes com hanseníase vivenciam situações de preconceito que, com o estigma e a discriminação, culminam para o isolamento social e a restrição dos relacionamentos sociais. O objetivo do presente estudo foi avaliar a percepção do paciente com hanseníase sobre sua qualidade de vida. Trata-se de um estudo transversal, quantitativo, cuja amostra de conveniência foi composta por 94 pacientes hansenianos, em fase de tratamento, que frequentavam as Unidades de Saúde do município de Cuiabá/MT, Brasil. Um questionário estruturado com dados sociodemográficos e informações sobre o conhecimento do paciente sobre a hanseníase, preconceito, autoestima e qualidade de vida, foi aplicado entre abril e agosto de 2018. Os resultados mostraram, na população investigada, um predomínio de indivíduos do sexo masculino (55,3%), com ensino médio completo (28,7%) e com renda entre 1 e 3 salários mínimos (67%). Os entrevistados apontaram como maior dificuldade do tratamento os efeitos colaterais (44,7%) e o período de duração (28,7%). A maioria dos investigados (72,3%) apresentava grande conhecimento sobre a doença, dentre os quais 26,6% já haviam sofrido a reação hansênica. 40,4% dos indivíduos encontravam-se deprimidos e tristes e 69,1%, tiveram problemas no emprego após o diagnóstico da doença. Quando a qualidade de vida foi investigada, 45,7% dos hansenianos classificaram os domínios avaliados entre ruim e muito ruim. A dor física foi associada ao impedimento do desempenho das tarefas diárias por 43,7% dos indivíduos. Pode-se concluir que a hanseníase causa sofrimento aos indivíduos que ultrapassa a dor e o mal-estar estritamente vinculados ao prejuízo físico, com grande impacto social e psicológico. (AU)
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ABSTRACT BACKGROUND AND OBJECTIVES: Chronic postsurgical pain is a major surgical complication with an impact on quality of life. Persistent pain following cervical fusion with iliac crest graft can be due to patient positioning, cervical surgical technique or nerve injury during iliac crest harvesting. Treatment options for chronic postsurgical pain overlap with those recommended for neuropathic pain. However, other pain mechanisms may be present in these patients. CASE REPORT: Male patient, 51-year-old, with persistent pain five years after emergency cervical arthrodesis with an iliac crest graft. The patient was referred to the chronic pain department (CPD) for management of meralgia paresthetica. However, other significant pain etiologies were found and treated such as nociceptive neck pain, myofascial lumbar pain, and inguinal neuropathic postsurgical pain. The therapeutic approach included multimodal pharmacotherapy with anticonvulsants, antidepressants, weak opioids, topical capsaicin 8% patch, as well as nerve blocks. After almost two years of follow-up, CPD discharge was possible, with minimal pain and return to baseline activity. CONCLUSION: Although the patient had a long course of undertreated postsurgical pain, a multimodal approach targeting different pain etiologies allowed the achievement of satisfactory pain control and return to baseline physical activity.
RESUMO JUSTIFICATIVA E OBJETIVOS: A dor crônica pós-operatória é uma importante complicação cirúrgica com impacto na qualidade de vida. A dor persistente após artrodese cervical pode ser secundária ao posicionamento do paciente, abordagem cirúrgica cervical ou lesão nervosa durante colheita de enxerto ilíaco. As opções terapêuticas para dor crônica pós-operatória têm alguma sobreposição com o tratamento da dor neuropática. No entanto, outros mecanismos de dor podem estar presentes nestes pacientes. RELATO DO CASO: Paciente do sexo masculino, 51 anos, que se apresentou com dor persistente cinco anos após artrodese cervical emergencial, com enxerto de crista ilíaca. Foi encaminhado para a unidade de dor crônica (UDC) para abordagem de meralgia parestésica. No entanto, foram encontradas e tratadas outras etiologias de dor: dor cervical nociceptiva; dor lombar miofascial e dor neuropática pós-operatória inguinal. A abordagem terapêutica utilizada incluiu farmacoterapia com anticonvulsivantes, antidepressivos e opioides fracos, adesivo de capsaicina a 8% e bloqueios regionais. Após quase dois anos de seguimento, foi possível oferecer alta da UDC com queixas álgicas mínimas e retorno da atividade física basal. CONCLUSÃO: Apesar de o paciente ter passado por um longo período sob tratamento insuficiente de dor pós-operatória, uma abordagem multimodal tendo como alvo diferentes etiologias de dor permitiu obter um controle álgico satisfatório e o retorno à atividade física basal.
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BACKGROUND: It is imperative to have effective programs to improve or maintain the health of aged people. AIM: To evaluate the effectiveness of an intervention based on a multidimensional program in Senior centers in Chile five months after its implementation, in the domains of physical and mental health, functionality and quality of life in aged people. MATERIAL AND METHODS: Sixty participants older than 60 years completed a multidimensional program for one month that included interventions of guided physical exercises, in addition to educational and social activities. They were evaluated at baseline and one and five months after the intervention. RESULTS: After the first and fifth months, significant improvements were observed in the five times sit to stand test (5TSTS) and gait speed (WST), in addition, significant improvements were observed in literacy measured by the Short Assessment of Health Literacy for Spanish-speaking Adults (SAHLSA). At the fifth month, slight improvements were observed in the Yesavage and short Falls efficacy scales, Barthel index, Unipodal Station and EuroQol five-dimensional quality of life tests. CONCLUSIONS: A multidimensional program for aged people lasting one month, improved the physical health dimension and literacy by the fifth month of evaluation.
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Humans , Middle Aged , Aged , Quality of Life , Senior Centers , Exercise/psychology , Chile , Educational StatusABSTRACT
A alopecia de padrão feminino figura dentre as queixas mais frequentes no consultório dermatológico e afeta até 50% das mulheres no climatério e na pós-menopausa. Apesar da existência de múltiplas terapias hoje disponíveis, algumas pacientes mostram-se refratárias aos tratamentos convencionais, sendo necessária a associação de tratamentos de segunda linha para a obtenção de bons resultados estéticos. Este trabalho ilustra as vantagens do microagulhamento nesse cenário por meio do relato de uma paciente de 48 anos de idade que não apresentou boa resposta clínica à associação do minoxidil tópico e à finasterida oral.
Female pattern hair loss (FPHL) is one of the most frequent complaints in dermatological practice. It affects up to 50% of climacteric and postmenopausal women. Despite multiple therapies available nowadays, some patients are refractory to conventional treatments, requiring the association of second-line therapies to obtain good aesthetic results. This paper aims to show the advantages of microneedling of the scalp for such cases by reporting the case of a 48-years-old patient who failed to the association of topical minoxidil and oral finasteride therapy
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Objective:To investigate the effects of standardized treatment combined with medical nutrition intervention on blood glucose level, body mass management and glucose metabolism at 3 months postpartum in patients with gestational diabetes mellitus (GDM).Methods:A total of 114 patients with GDM who received treatment in Shunyi District Hospital of Beijing from June 2017 to October 2019 were included in this study. They were randomly divided into observation group ( n = 57) and control group ( n = 57). The control group was treated with standardized therapy, and the observation group was treated with standardized therapy combined with medical nutrition intervention. Blood glucose level, body mass management, glucose metabolism outcomes at 3 months postpartum, pregnancy outcome, and neonatal outcome were compared between the two groups. Results:After treatment, hemoglobin A1c (HbA1c), fasting blood glucose, 2-hour plasma glucose (2hPG) after breakfast, and 2hPG after dinner in the observation group were (5.20 ± 0.34)%, (4.69 ± 0.31) mmol/L, (7.32 ± 2.13) mmol/L, and (7.54 ± 2.36) mmol/L, respectively, which were significantly lower than those in the control group [(6.38 ± 0.42)%, (6.34 ± 0.45) mmol/L, (9.01 ± 2.27) mmol/L, (9.35 ± 2.47) mmol/L, t = 16.48, 22.79, 4.09, 4.00, all P < 0.001]. The increases in body mass and body mass index during pregnancy in the observation groups were (12.19 ± 2.35) kg and (4.52 ± 1.13) kg/m 2, respectively, which were significantly lower than those in the control group [(16.21 ± 2.64) kg, (6.11 ± 1.25) kg/m 2, t = 8.58, 7.12, both P < 0.001]. The abnormal rate of glucose metabolism at 3 months postpartum in the observation group was significantly lower than that in the control group [5.3% (3/57) vs. 8.8% (5/57), χ2 = 0.53, P = 0.462]. The incidences of premature rupture of membranes, polyhydramnios, and cesarean section in the observation group were 5.3% (3/57), 14.0% (8/57) and 15.8% (9/57), which were significantly lower than those in the control group [22.8% (13/57), 35.1% (20/57), 40.4% (23/57), χ2 = 7.27, 6.81, 8.51, all P < 0.05]. There were no significant differences in the incidences of pregnancy-induced hypertension and postpartum hemorrhage between the two groups (both P > 0.05). The incidences of premature births, macrosomia, respiratory distress, neonatal hypoglycemia and hyperbilirubinemia in the observation groups were 5.3% (3/57), 3.5% (2/57), 7.0% (4/57), 3.5% (2/57), 5.3% (3/57), respectively, which were significantly lower than those in the control group [22.8% (13/57), 17.5% (10/57), 21.1% (12/57), 15.8% (9/57), 19.3% (11/57), χ2 = 7.27, 5.96, 5.60, 4.93, 5.21, all P < 0.05). Conclusion:Standardized treatment combined with medical nutrition intervention can effectively reduce blood glucose level in patients with GMD, control body mass, and improve glucose metabolism at 3 months after delivery.