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2.
J Orthop Surg Res ; 18(1): 165, 2023 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-36869376

RESUMO

BACKGROUND: The objective of this prospective randomized monocentric study is to compare the speed and quality of interbody fusion of implanted porous Al2O3 (aluminium oxide) cages with PEEK (polyetheretherketone) cages in ACDF (anterior cervical discectomy and fusion). MATERIALS AND METHODS: A total of 111 patients were enrolled in the study, which was carried out between 2015 and 2021. The 18-month follow-up (FU) was completed in 68 patients with an Al2O3 cage and 35 patients with a PEEK cage in one-level ACDF. Initially, the first evidence (initialization) of fusion was evaluated on computed tomography. Subsequently, interbody fusion was evaluated according to the fusion quality scale, fusion rate and incidence of subsidence. RESULTS: Signs of incipient fusion at 3 months were detected in 22% of cases with the Al2O3 cage and 37.1% with the PEEK cage. At 12-month FU, the fusion rate was 88.2% for Al2O3 and 97.1% for PEEK cages, and at the final FU at 18 months, 92.6% and 100%, respectively. The incidence of subsidence was observed to be 11.8% and 22.9% of cases with Al2O3 and PEEK cages, respectively. CONCLUSIONS: Porous Al2O3 cages demonstrated a lower speed and quality of fusion in comparison with PEEK cages. However, the fusion rate of Al2O3 cages was within the range of published results for various cages. The incidence of subsidence of Al2O3 cages was lower compared to published results. We consider the porous Al2O3 cage as safe for a stand-alone disc replacement in ACDF.


Assuntos
Óxido de Alumínio , Discotomia , Humanos , Porosidade , Estudos Prospectivos , Cetonas , Polietilenoglicóis
3.
Pharmacoepidemiol Drug Saf ; 31(10): 1046-1055, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35791700

RESUMO

PURPOSE: The COVID-19 pandemic had an impact on health care, with disruption to routine clinical care. Our aim was to describe changes in prescription drugs dispensing in the primary and outpatient sectors during the first year of the pandemic across Europe. METHODS: We used routine administrative data on dispensed medicines in eight European countries (five whole countries, three represented by one region each) from January 2017 to March 2021 to compare the first year of the COVID-19 pandemic with the preceding 3 years. RESULTS: In the 10 therapeutic subgroups with the highest dispensed volumes across all countries/regions the relative changes between the COVID-19 period and the year before were mostly of a magnitude similar to changes between previous periods. However, for drugs for obstructive airway diseases the changes in the COVID-19 period were stronger in several countries/regions. In all countries/regions a decrease in dispensed DDDs of antibiotics for systemic use (from -39.4% in Romagna to -14.2% in Scotland) and nasal preparations (from -34.4% in Lithuania to -5.7% in Sweden) was observed. We observed a stockpiling effect in the total market in March 2020 in six countries/regions. In Czechia the observed increase was not significant and in Slovenia volumes increased only after the end of the first lockdown. We found an increase in average therapeutic quantity per pack dispensed, which, however, exceeded 5% only in Slovenia, Germany, and Czechia. CONCLUSIONS: The findings from this first European cross-national comparison show a substantial decrease in dispensed volumes of antibiotics for systemic use in all countries/regions. The results also indicate that the provision of medicines for common chronic conditions was mostly resilient to challenges faced during the pandemic. However, there were notable differences between the countries/regions for some therapeutic areas.


Assuntos
COVID-19 , Antibacterianos , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Prescrições de Medicamentos , Humanos , Pandemias , Padrões de Prática Médica
4.
Biomed Res Int ; 2021: 9996193, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34676266

RESUMO

BACKGROUND: Diabetes mellitus rates and associated costs continue to rise across Europe enhancing health authority focus on its management. The risk of complications is enhanced by poor glycaemic control, with long-acting insulin analogues developed to reduce hypoglycaemia and improve patient convenience. There are concerns though with their considerably higher costs, but moderated by reductions in complications and associated costs. Biosimilars can help further reduce costs. However, to date, price reductions for biosimilar insulin glargine appear limited. In addition, the originator company has switched promotional efforts to more concentrated patented formulations to reduce the impact of biosimilars. There are also concerns with different devices between the manufacturers. As a result, there is a need to assess current utilisation rates for insulins, especially long-acting insulin analogues and biosimilars, and the rationale for patterns seen, among multiple European countries to provide future direction. Methodology. Health authority databases are examined to assess utilisation and expenditure patterns for insulins, including biosimilar insulin glargine. Explanations for patterns seen were provided by senior-level personnel. RESULTS: Typically increasing use of long-acting insulin analogues across Europe including both Western and Central and Eastern European countries reflects perceived patient benefits despite higher prices. However, activities by the originator company to switch patients to more concentrated insulin glargine coupled with lowering prices towards biosimilars have limited biosimilar uptake, with biosimilars not currently launched in a minority of European countries. A number of activities were identified to address this. Enhancing the attractiveness of the biosimilar insulin market is essential to encourage other biosimilar manufacturers to enter the market as more long-acting insulin analogues lose their patents to benefit all key stakeholder groups. CONCLUSIONS: There are concerns with the availability and use of insulin glargine biosimilars among European countries despite lower costs. This can be addressed.


Assuntos
Medicamentos Biossimilares/uso terapêutico , Análise Custo-Benefício/tendências , Diabetes Mellitus/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Insulina Glargina/uso terapêutico , Insulina de Ação Prolongada/uso terapêutico , Educação de Pacientes como Assunto/métodos , Medicamentos Biossimilares/economia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/economia , Europa (Continente) , Humanos , Hipoglicemiantes/economia , Insulina Glargina/economia , Insulina de Ação Prolongada/economia
5.
Curr Oncol ; 28(4): 2914-2927, 2021 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-34436021

RESUMO

BACKGROUND: Secondary tumors of the ovary (STOs) account for 10-25% of all ovarian malignancies, including metastases from primary gynecological tumors. Colorectal cancer (CRC) has been recognized as one of the most common causes of STOs in Western countries. Despite it being well-known that CRC originating from the right versus left side of the colon/rectum differ substantially, there is a paucity of information regarding the effect of the primary tumor sidedness on the clinicopathological characteristics of STOs. METHODS: This retrospective, observational chart review study included patients with histologically confirmed STOs of CRC origin diagnosed between January 2000 and December 2019. The clinicopathological characteristics of STOs originating from left-sided and right-sided CRC were compared. Univariable and multivariable analyses employing elastic net Cox proportional hazard models were used to evaluate potential prognostic factors. Further, the role of imaging methods in STOs diagnostics was evaluated. RESULTS: Fifty-one patients with STOs of colorectal origin were identified. The primary tumor originated in the right and left colon/rectum in 39% and 61% of the cases, respectively. STOs originating from right-sided primary tumors were more frequently bilateral, associated with peritoneal carcinomatosis, had the ovarian surface affected by the tumor, and contained a mucinous component. The independent prognostic factors for overall survival in the whole cohort included: the presence of macroscopic residual disease after cytoreductive surgery, menopausal status, the application of systemic therapy, and the application of targeted therapy. In 54% of cases, the imaging methods failed to determine the laterality of the STOs correctly as compared to pathological reports and/or intraoperative findings. CONCLUSION: STOs originating from left-sided and right-sided CRC show distinct clinicopathological characteristics. Moreover, different metastatic pathways might be employed according to the primary tumor sidedness. Considering the discrepancies between radiological assessment and histopathological findings regarding the laterality of STOs, bilateral adnexectomy should be advised whenever feasible.


Assuntos
Neoplasias Colorretais , Neoplasias Peritoneais , Feminino , Humanos , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos
6.
Eur J Clin Pharmacol ; 77(10): 1553-1561, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33938975

RESUMO

PURPOSE: The aim of this study was to explore patterns and long-term development in prescribing potentially inappropriate medication (PIM) according to the EU(7)-PIM list to elderly patients in Germany. METHODS: We analysed anonymized German claims data. The study population comprised 6.0 million insured individuals at least 65 years old, including all their prescriptions reimbursed in 2019. For the analysis of long-term development, we used data for the years 2009-2019. Factors associated with PIM prescribing were considered from two perspectives: patient-oriented analysis was performed with logistic regression and prescriber-oriented analysis was performed with multiple linear regression. RESULTS: EU(7)-PIM prevalence was reduced from 56.9% in 2009 to 45.1% in 2019. Average annual volume (DDDs/insured) decreased from 145 in 2009 to 121 in 2019. These figures are substantially greater than those for the older PRISCUS list. The majority of investigated ATC level 2 groups with the highest EU(7)-PIM DDD volume exhibited substantial decreases; moderate increases were found for antihypertensive and urological drugs. Antithrombotics increased strongly with the introduction of direct oral anticoagulants. The most prevalent EU(7)-PIM medication was diclofenac; however, in the age group 85+ years, apixaban was twice as prevalent as diclofenac. Polypharmacy, female sex, age < 90 years, need for nursing care and living in Eastern regions were identified as risk factors. Prescriber specialty was the most marked factor in the prescriber-oriented analysis. CONCLUSION: Although the use of EU(7)-PIMs has been declining, regional differences indicate considerable room for improvement. The comparison with PRISCUS highlights the necessity of regular updates of PIM lists.


Assuntos
Lista de Medicamentos Potencialmente Inapropriados/estatística & dados numéricos , Lista de Medicamentos Potencialmente Inapropriados/tendências , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Alemanha/epidemiologia , Humanos , Revisão da Utilização de Seguros/estatística & dados numéricos , Polimedicação , Características de Residência , Estudos Retrospectivos , Fatores Sexuais
7.
Expert Rev Pharmacoecon Outcomes Res ; 21(4): 527-540, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33535841

RESUMO

Introduction: There are growing concerns among European health authorities regarding increasing prices for new cancer medicines, prices not necessarily linked to health gain and the implications for the sustainability of their healthcare systems.Areas covered: Narrative discussion principally among payers and their advisers regarding potential approaches to the pricing of new cancer medicines.Expert opinion: A number of potential pricing approaches are discussed including minimum effectiveness levels for new cancer medicines, managed entry agreements, multicriteria decision analyses (MCDAs), differential/tiered pricing, fair pricing models, amortization models as well as de-linkage models. We are likely to see a growth in alternative pricing deliberations in view of ongoing challenges. These include the considerable number of new oncology medicines in development including new gene therapies, new oncology medicines being launched with uncertainty regarding their value, and continued high prices coupled with the extent of confidential discounts for reimbursement. However, balanced against the need for new cancer medicines. This will lead to greater scrutiny over the prices of patent oncology medicines as more standard medicines lose their patent, calls for greater transparency as well as new models including amortization models. We will be monitoring these developments.


Assuntos
Antineoplásicos/economia , Atenção à Saúde/economia , Custos de Medicamentos/tendências , Neoplasias/tratamento farmacológico , Custos e Análise de Custo , Desenvolvimento de Medicamentos , Europa (Continente) , Humanos , Modelos Econômicos , Neoplasias/economia , Patentes como Assunto , Mecanismo de Reembolso/economia
8.
Brain Sci ; 10(10)2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33019758

RESUMO

Brain ischemia after central nervous system (CNS) bleeding significantly influences the final outcome of patients. Catalytic activities of aspartate aminotransferase (AST) in the cerebrospinal fluid (CSF) to detect brain ischemia were determined in this study. The principal aim of our study was to compare the dynamics of AST in 1956 CSF samples collected from 215 patients within a 3-week period after CNS hemorrhage. We compared concentrations of the AST catalytic activities in the CSF of two patient groups: survivors (Glasgow Outcome Score (GOS) 5-3) and patients in a vegetative state or dead (GOS 2-1). All statistical evaluations were performed using mixed models and the F-test adjusted by Kenward and Roger and the Bonferroni adjustment for multiple tests. The significantly higher catalytic activities of AST in the CSF from patients with the GOS of 2-1 when compared to those who survived (GOS 5-3, p = 0.001) were found immediately after CNS haemorrhage. In the further course of time, the difference even increased (p < 0.001). This study confirmed the key association between early signs of brain damage evidenced as an elevated AST activity and the prediction of the final patient's clinical outcome. The study showed that the level of AST in the CSF could be the relevant diagnostic biomarker of the presence and intensity of brain tissue damage.

9.
PLoS One ; 15(7): e0235842, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32639989

RESUMO

Biodegradable stents are promising treatments for many diseases, e.g., coronary artery disease, urethral diseases, tracheal diseases, and esophageal strictures. The mechanical properties of biodegradable stent materials play a key role in the safety and efficacy of treatment. In particular, insufficient creep resistance of the stent material could result in premature stent collapse or narrowing. Commercially available biodegradable self-expandable SX-ELLA stents made of polydioxanone monofilament were tested. A new, simple, and affordable method to measure the shear modulus of tiny viscoelastic wires is presented. The important mechanical parameters of the polydioxanone filament were obtained: the median Young's modulus was [Formula: see text] = 958 (922, 974) MPa and the shear modulus was [Formula: see text] = 357 (185, 387) MPa, resulting in a Poisson's ratio of ν = 0.34. The SX-ELLA stents exhibited significant force relaxation due to the stress relaxation of the polydioxanone monofilament, approximately 19% and 36% 10 min and 48 h after stent application, respectively. However, these results were expected, and the manufacturer and implanting clinician should be aware of the known behavior of these biodegradable materials. If possible, a biodegradable stent should be designed considering therapeutic force rather than initial force. Additionally, new and more advanced biodegradable shape-memory polymers should be considered for future study and use.


Assuntos
Implantes Absorvíveis , Materiais Biocompatíveis/química , Polidioxanona/química , Stents , Módulo de Elasticidade , Humanos , Teste de Materiais , Fenômenos Mecânicos , Desenho de Prótese
10.
Curr Med Res Opin ; 35(4): 697-704, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30362365

RESUMO

OBJECTIVE: Combined hormonal contraceptives (CHC) exhibit differing risks for cardiovascular and thrombotic events (VTE). A European referral process confirmed higher VTE risks for 3rd generation gestagens and drospirenone. CHC are now grouped in risk classes (RC) I, II, and III, with RC III having a higher risk than RC I and X (risk not yet known). Marketing authorization holders were obliged to implement pharmacovigilance measures and risk minimization measures including changes of prescribing information. The study assessed whether these activities induced changes in prescription patterns. METHODS: German prescription data for 1.1 million women below 20 years of age were used to analyze the effects of interventions and potential influence factors using logistic regression. Descriptive statistics were calculated for prescriptions for 3.3 million women from January 2011 to March 2016. RESULTS: Shares of RC I and RC X recipients rose substantially over the observation period, while RC III recipient share showed a steady decrease. The referral induced a slightly faster decrease in RC III and increase in RC X. The implementation of pharmacovigilance measures manifested no additional effect. CONCLUSION: The decrease in RC III share already observed before the referral process can be explained with pre-existing discussions around CHC. The effect attributable to the referral was statistically significant, although very small. While evidence for a connection between interventions and prescription change is only indirect, the study shows that routine data are suitable for impact analyses, and monitoring prescribing patterns can be recommended as feedback after regulatory or political interventions. This is being followed up.


Assuntos
Anticoncepcionais Orais Combinados , Prescrições de Medicamentos , Medição de Risco , Adulto , Indústria Farmacêutica/legislação & jurisprudência , Prescrições de Medicamentos/normas , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Alemanha , Humanos , Adulto Jovem
11.
Artigo em Inglês | MEDLINE | ID: mdl-29582860

RESUMO

AIMS: Critically ill patients undergoing aggressive fluid resuscitation and treated empirically with hydrosoluble time-dependent beta-lactam antibiotics are at risk for sub-therapeutic plasma concentrations. The aim of this study was to assess the impact of two covariates - creatinine clearance (Clcr) and cumulative fluid balance (CFB) on pharmacokinetics/pharmacodynamics (PK/PD) target attainment within a week of treatment with meropenem (ME) or piperacillin/tazobactam (PIP/TZB). METHODS: In this prospective observational pharmacokinetic (PK) study, 18 critically ill patients admitted to a surgical Intensive Care Unit (ICU) were enrolled. The primary PK/PD target was free antibiotic concentrations above MIC at 100% of the dosing interval (100%fT>MIC) to obtain maximum bactericidal activity. Drug concentration was measured using liquid chromatography-tandem mass spectrometry. RESULTS: The treatment of both 8 septic patients with IV extended ME dosing 2 g/3 h q8 h and 10 polytraumatized patients with IV intermittent PIP/TZB dosing 4.0/0.5 g q8 h was monitored. 8/18 patients (44%) manifested augmented renal clearence (ARC) where Clcr ≥130 mL/min/1.73 m2. Maximum changes were reported on days 2-3: the median positive CFB followed by the large median volume of distribution: Vdme=70.3 L (41.9-101.5), Vdpip = 46.8 L (39.7-60.0). 100%fTme>MIC was achieved in all patients on ME (aged ≥60 years), and only in two patients (non-ARC, aged ≥65 years) out of 10 on PIP/TZB. A mixed model analysis revealed positive relationship of CFBpip with Vdpip (P=0.021). CONCLUSION: Assuming that the positive correlation between CFB and Vd exists for piperacillin in the setting of the pathological state, then CFB should predict Vdpip across subjects at each and every time point.


Assuntos
Antibacterianos/administração & dosagem , Estado Terminal/terapia , Meropeném/administração & dosagem , Piperacilina/administração & dosagem , beta-Lactamas/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacocinética , Antibacterianos/farmacologia , Esquema de Medicação , Feminino , Humanos , Masculino , Meropeném/farmacocinética , Meropeném/farmacologia , Pessoa de Meia-Idade , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/tratamento farmacológico , Peritonite/complicações , Peritonite/tratamento farmacológico , Piperacilina/farmacocinética , Piperacilina/farmacologia , Estudos Prospectivos , Sepse/tratamento farmacológico , Choque Séptico/tratamento farmacológico , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Resultado do Tratamento , Adulto Jovem , beta-Lactamas/farmacocinética , beta-Lactamas/farmacologia
12.
Complement Med Res ; 25(3): 159-166, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29073607

RESUMO

BACKGROUND: The prevalence of complementary and alternative medicine (CAM) ranges between 0.3% and 86% in most highly developed countries. In the Czech Republic, CAM is used by 76% of the general population. Our aim was to examine patterns in CAM use among a representative sample of the general population in the Czech Republic, for 2011 and 2014. MATERIAL AND METHODS: A cross-sectional survey was conducted. A sex-, age- and region-stratified sample of citizens aged 15 years and older was randomly selected from the 2014 voter registration lists (n = 8,395,132). A comparative analysis of data collected in 2011 and 2014 was performed. RESULTS: Overall, 76.0% (N = 1,365) versus 87.0% (N = 1,565) of the respondents reported use of 1 or more CAM modalities during the past 30 days, in 2011 and 2014, respectively (p < 0.001). In both years, the top 4 CAM modalities used were vitamins/minerals, herbal teas, massage, and relaxation. Yoga replaced dietary supplements excluding vitamins/minerals in the 5th position. Nevertheless, only herbal teas (48.0% vs. 53.0%, p = 0.002), massage (20.0% vs. 26.0%, p < 0.001), relaxation (10.0% vs. 19.0%, p < 0.001), and yoga (3.7% vs. 7.1%, p < 0.001) showed a significant increase in use. CONCLUSIONS: The prevalence of CAM use in the Czech Republic is increasing, especially among people who use biological, body- and mind-based CAM therapies. There is a great need to educate students and health care professionals about the efficacy and safety of CAM in order to meet the patients' demands on CAM.


Assuntos
Terapias Complementares/estatística & dados numéricos , Adolescente , Adulto , Idoso , Estudos Transversais , República Tcheca , Demografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
13.
Toxicol In Vitro ; 44: 361-371, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28746894

RESUMO

Skin and membrane permeation experiments comprise an important step in the development of a transdermal or topical formulation or toxicological risk assessment. The standard method for analyzing these data relies on the linear part of a permeation profile. However, it is difficult to objectively determine when the profile becomes linear, or the experiment duration may be insufficient to reach a maximum or steady state. Here, we present a software tool for Skin And Membrane Permeation data Analysis, SAMPA, that is easy to use and overcomes several of these difficulties. The SAMPA method and software have been validated on in vitro and in vivo permeation data on human, pig and rat skin and model stratum corneum lipid membranes using compounds that range from highly lipophilic polycyclic aromatic hydrocarbons to highly hydrophilic antiviral drug, with and without two permeation enhancers. The SAMPA performance was compared with the standard method using a linear part of the permeation profile and a complex mathematical model. SAMPA is a user-friendly, open-source software tool for analyzing the data obtained from skin and membrane permeation experiments. It runs on a Microsoft Windows platform and is freely available as a Supporting file to this article.


Assuntos
Absorção Cutânea , Software , Animais , Permeabilidade da Membrana Celular , Humanos , Preparações Farmacêuticas/metabolismo , Ratos , Pele/metabolismo , Suínos
14.
Artigo em Inglês | MEDLINE | ID: mdl-27283756

RESUMO

AIMS: Goeckerman therapy is based on combined exposure to UV radiation (UVA, UVB) and crude coal tar (PAHs). Some indicators suggest a genotoxic hazard, however, the level of genotoxic risk of the therapy has not yet been investigated sufficiently. This study aims to assesss the genotoxic risk. METHODS: The studied group consisted of patients with chronic stable plaque psoriasis treated by Goeckerman therapy (n = 29). Heparin-treated peripheral blood samples were collected one day before the first treatment and immediately after the last procedure. The lymphocytes were isolated from the blood. The level of genotoxicity was evaluated using an alkaline version of the Comet assay which detects DNA single strand breaks (DNA-SSBs), a neutral version of the Comet assay which detects DNA double strand breaks (DNA-DSBs), and using chromosomal aberrations. RESULTS: The level of DNA-SSBs increased insignificantly (median; Q1-Q3): 1.4 (0.4; 0.1-1.4) vs. 2.5 (0.6; 0.3-2.7) %tDNA (P = 0.11) and the level of DNA-DSBs increased significantly: 7.8 (6.5; 3.4-10.5) vs. 20.7 (19.3; 14.2-24.6) % DNA (P < 0.001). The total number of aberrated cells (P < 0.001) and structurally aberrated cells (P < 0.001) increased significantly. CONCLUSION: The elevated levels of the DNA-DSBs and the chromosomal aberrations in the peripheral lymphocytes indicated a genotoxic hazard. However, the elevated level of the chromosomal abnormalities was below the upper level of the reference range for healthy Czech adults. While, the genotoxic risk appears to be low, Goeckerman treatment represents a further contribution to the lifetime load of genotoxic factors.


Assuntos
Alcatrão/efeitos adversos , Ceratolíticos/efeitos adversos , Linfócitos , Psoríase/terapia , Terapia Ultravioleta/efeitos adversos , Adulto , Idoso , Aberrações Cromossômicas/efeitos dos fármacos , Aberrações Cromossômicas/efeitos da radiação , Doença Crônica , Quebras de DNA de Cadeia Dupla/efeitos dos fármacos , Quebras de DNA de Cadeia Dupla/efeitos da radiação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Raios Ultravioleta/efeitos adversos
15.
Forsch Komplementmed ; 23(1): 22-8, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26978161

RESUMO

BACKGROUND: Prevalence rates of complementary and alternative medicine (CAM) use are still missing for some European countries, especially in the East. Thus, we measured patterns and determinants of CAM use among a representative sample of the general population in the Czech Republic. METHODS: A cross-sectional survey was conducted. A sex-, age- and region-stratified sample of citizens aged 15 and older were randomly selected from voter registration lists (n = 8,639,375). RESULTS: Overall, 76.0% (n = 1,365) of the respondents reported use of one or more CAM modalities during the past 30 days. The top five CAM modalities used were vitamins/minerals (54.6%), herbal remedies (47.8%), massage (19.9%), relaxation techniques (9.5%), and dietary supplements excluding vitamins/minerals (9.2%). Prevention (82.0%) was the primary reason for CAM use. Only 15.9% of CAM users employed it for therapeutic purposes. The most commonly treated ailments were respiratory (35.0%) and musculoskeletal (33.6%) disorders. CONCLUSION: The prevalence of CAM use in the Czech Republic is high, especially among people who apply CAM for self-treatment prior to seeing a doctor. Half of the study population combined CAM with conventional medical treatment, which may result in potential harm to the patient. Healthcare providers as well as the public should be educated about effective and safe use of CAM.


Assuntos
Terapias Complementares/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , República Tcheca , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
16.
Cancer Chemother Pharmacol ; 77(2): 429-37, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26678853

RESUMO

PURPOSE: To examine the removal of pegylated liposomal doxorubicin (PLD) during plasmafiltration (PF) and determine whether the drug could be withheld prior to its organ distribution responsible for mucocutaneous toxicity. METHODS: Six patients suffering from platinum-resistant ovarian cancer were treated with a 1-h IV infusion 50 mg/m(2) of PLD/cycle-for three cycles q4w. Over 44 (46)-47(49) h postinfusion, five patients (14 cycles in total) underwent PF using a cascade PF method consisted of plasma separation by centrifugation and plasma treatment using filtration based one volume of plasma treatment, i.e., 3.18 L (±0.6 L) and plasma flow 1.0 L/h (0.91-1.48 L/h). Doxorubicin concentration in blood was monitored by a high-performance liquid chromatography method for 116 h postinfusion. Pharmacokinetic parameters determined from plasma concentration included volume of distribution, total body clearance, half-life of elimination, and area under the plasma concentration versus time. The amount of doxorubicin in the body eliminated by the patient and via extracorporeal treatment was evaluated. Toxicity was tested using CTCAE v4.0. RESULTS: The efficacy of PF and early responses to PLD/PF combination strategy were as follows: over 44(46) h postinfusion considered necessary for target distribution of PLD to tumor, patients eliminated 46 % (35-56 %) of the dose administered. Over 44(46)-47(49) h postinfusion, a single one-volume plasma filtration removed 40 % (22-45 %) (Mi5) of the remaining doxorubicin amount in the body. Total fraction eliminated attained 81 % (75-86 %). The most common treatment-related adverse events (grade 1-2) such as nausea (4/14 cycles-28 %) and vomiting (3/14 cycles-21 %) appeared during 44 h postinfusion. Hematological toxicity-anemia (5/14 cycles-35 %) was reported after cycle II termination. Symptoms of PPE-like syndrome (grade 1-2) appeared in one patient concomitantly with thrombophlebitis and malignant effusion. In this study, only one adverse reaction (1/14-7 %) as short-term malaise and nausea was reported by the investigator as probably related to PF. CONCLUSION: A single one-volume PF does remove a clinically important amount of doxorubicin in a kinetic targeting approach. There were no serious signs of drug toxicity and/or PF-related adverse events. Kinetically guided therapy with pegylated liposomal doxorubicin combined with PF may be a useful tool to the higher efficacy and tolerability of therapy with PLD.


Assuntos
Doxorrubicina/análogos & derivados , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Neoplasias das Tubas Uterinas , Hemofiltração/métodos , Neoplasias Ovarianas , Adulto , Idoso , Antibióticos Antineoplásicos/administração & dosagem , Antibióticos Antineoplásicos/efeitos adversos , Antibióticos Antineoplásicos/sangue , Antibióticos Antineoplásicos/farmacocinética , Área Sob a Curva , Progressão da Doença , Doxorrubicina/administração & dosagem , Doxorrubicina/efeitos adversos , Doxorrubicina/sangue , Doxorrubicina/farmacocinética , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Neoplasias das Tubas Uterinas/tratamento farmacológico , Neoplasias das Tubas Uterinas/patologia , Feminino , Meia-Vida , Hemofiltração/efeitos adversos , Humanos , Taxa de Depuração Metabólica , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Órgãos em Risco , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/patologia , Polietilenoglicóis/administração & dosagem , Polietilenoglicóis/efeitos adversos , Polietilenoglicóis/farmacocinética , Resultado do Tratamento
17.
Am J Orthod Dentofacial Orthop ; 146(3): 319-27, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25172254

RESUMO

INTRODUCTION: The aim was to study nickel-titanium closed-coil springs in a clinically relevant test setting with respect to the accuracy of the "preactivation" for nickel-titanium closed-coil springs application and whether it is possible to keep activation forces constant during the whole time of treatment. METHODS: We tested 10 types of springs from 5 manufacturers under clinically relevant conditions, allowing us to study the interactions between load and temperature over time. Hystereses were compared using t tests. RESULTS: Springs with a large mechanical hysteresis also showed a large thermal hysteresis. After heating shock, these springs showed intensive force spikes and persistent high loads. Some springs showed negligible thermal and mechanical hysteresis. Such springs never showed any clinically significant persistent high loads. CONCLUSIONS: Springs with a large hysteresis were unable to keep activation forces constant during the whole time of treatment even after any preactivation, and they might cause persistently high loads and possibly overloading. Only springs with minor hysteresis, low temperature dependence of force, and a clinically useful plateau have the following clinical advantages: reduced chair time, optimal rates of tooth movement, reproducible clinical results, and conservation of anchorage.


Assuntos
Ligas Dentárias/química , Níquel/química , Fios Ortodônticos , Titânio/química , Temperatura Baixa , Análise do Estresse Dentário/instrumentação , Elasticidade , Temperatura Alta , Humanos , Teste de Materiais , Fenômenos Mecânicos , Estresse Mecânico , Termodinâmica , Torção Mecânica
18.
Clin Chem Lab Med ; 52(7): 1009-17, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24622789

RESUMO

BACKGROUND: The concentrations of glucose and lactate in cerebrospinal fluid (CSF) provide important information about energy metabolism in the CSF compartment. To improve our understanding of this information we introduced a new parameter resulting from a formula for calculating the fictitious production of adenosine triphosphate, i.e., the coefficient of energy balance (KEB). METHODS: We evaluated cytology, the concentrations of glucose and lactate and the KEB in the CSF of 948 patients, who were divided into five groups. For statistical analysis we used the Kruskal-Wallis test with post-hoc analysis using the Dunn method and multinomial regression analysis. We determined the specificities and sensitivities of the cytological pictures and the KEB. RESULTS: A KEB>28.0 corresponded to normal energy metabolism in the CSF. A KEB<28.0 corresponded to an increased level of anaerobic metabolism in the CSF during inflammation in the CNS. A KEB<10.0 corresponded to a high level of anaerobic metabolism in the CSF during severe inflammation with an oxidative burst of professional phagocytes in the CNS. The KEB parameter increased the specificities of cytological examinations of the CSF in all cases. CONCLUSIONS: The KEB represents an equation for calculating the fictitious average number of ATP molecules produced in the CSF compartment from one molecule of glucose, and we used it successfully as a new parameter for evaluating energy metabolism status in the CSF.


Assuntos
Doenças do Sistema Nervoso Central/diagnóstico , Líquido Cefalorraquidiano/química , Metabolismo Energético , Glucose/análise , Ácido Láctico/análise , Trifosfato de Adenosina/biossíntese , Doenças do Sistema Nervoso Central/líquido cefalorraquidiano , Doenças do Sistema Nervoso Central/imunologia , Doenças do Sistema Nervoso Central/metabolismo , Líquido Cefalorraquidiano/metabolismo , Glucose/metabolismo , Humanos , Inflamação/diagnóstico , Inflamação/imunologia , Inflamação/metabolismo , Ácido Láctico/metabolismo , Análise de Regressão
19.
J Asthma ; 50(3): 318-26, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23379542

RESUMO

OBJECTIVE: The aim of the study was to investigate the effectiveness and feasibility of conducting a complementary 8-week comprehensive lifestyle modification program (CLMP) compared to standard care in patients with bronchial asthma over a 6-month period. METHODS: This was a randomized controlled pilot trial with two groups: intervention (N = 15) group and attention-placebo control (N = 14) group. The intervention group received an 8-week CLMP in addition to standard care. Quality of life, asthma control, lung function, reduction of rescue medication, perceived stress, and psychosocial and spiritual status were measured at the end of the intervention and at the 4-month follow-up. RESULTS: In the intervention group, there was a statistically significant difference in the improvements of quality of life, asthma control, lung function, and the reduction of rescue medication intake at both the end of the intervention and at the 4-month follow-up, with no change being observed in the control group. Significant stress reduction and greater psychosocial and spiritual well-being were observed during the 8-week CLMP in the intervention group. At the end of the intervention, the measures of stress and psychological and spiritual well-being reached statistical significance. CONCLUSIONS: Preliminary findings suggest that adding a CLMP to standard care in patients with bronchial asthma offers greater clinical benefit than standard care alone and also suggest that conducting a large randomized clinical trial is feasible.


Assuntos
Antiasmáticos/administração & dosagem , Asma/terapia , Terapia Comportamental/métodos , Asma/tratamento farmacológico , Asma/fisiopatologia , Asma/psicologia , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Qualidade de Vida , Testes de Função Respiratória , Estatísticas não Paramétricas
20.
Ther Innov Regul Sci ; 47(3): 341-348, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-30231436

RESUMO

The main objective of this study was to assess the factor structure and psychometric properties of the Czech translation of the Beliefs about Medicines Questionnaire (BMQ-CZ). It was hypothesized that the 4-factor structure of the BMQ-CZ would be confirmed and that psychometric properties would be verified by using positive or negative correlations with self-reported adherence, illness perceptions, and medication statements. A total of 627 people were approached, and 467 agreed to participate. The sample included chronically ill patients as well as patients seeking allopathic and homeopathic care. As a measure of criterion-related validity, the BMQ-CZ was administered along with the translated Czech versions of the Medication Adherence Report Scale (MARS-CZ) and the Brief Illness Perception Questionnaire (Brief IPQ-CZ) and additional assertions. The factor structure, reliability, and validity of the BMQ-CZ were evaluated. The internal consistency of the BMQ-CZ was satisfactory (Cronbach α = .69-.85). A factor analysis supported the BMQ-CZ's 4-factor structure, and the concurrrent validity of the BMQ-CZ was supported by positive correlations with self-reported measures of adherence and beliefs about medicines and disease. The BMQ-CZ demonstrated sufficient psychometric performance as a self-reported measure of medication beliefs among patients with hypertension, diabetes, and rheumatic disease.

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