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Cardiovascular & Hematological Agents... 2021Acute porphyrias cause life-threatening attacks of neurovisceral non-specific symptoms, so this condition mimics many acute medical and psychiatric diseases. The disease... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Acute porphyrias cause life-threatening attacks of neurovisceral non-specific symptoms, so this condition mimics many acute medical and psychiatric diseases. The disease is very misdiagnosed, probably due to its low incidence and non-pathognomonic symptoms, this delays the effective treatment onset. Early diagnosis and treatment highly improve the prognosis and can prevent the development of neuropathic manifestations.
METHODS
We assembled a systematic review, following the PRISMA guidelines and using Pubmed as our database. Our aim was to show some peculiarities among patients that present neurological manifestations in acute porphyria attack. We obtained the patients' age, sex, clinical presentation, eurological manifestations and porphyria type of 16 patients. We also evaluated the time between symptoms onset and neurological manifestations. The average age was 28,4 ± 11,1; 50% of patients were male.
RESULTS
AIP was the most prevalent porphyria type. The average time between symptoms onset and neurological manifestations was of 9,53 ± 11,6 days. Abdominal pain; nausea and vomiting and psychiatric manifestations were the most common symptoms preceding neurological attacks. Seizures and consciousness disturbance were the most prevalent findings within an attack. We also presenting a case to illustrate how difficult this diagnosis can be.
Topics: Abdominal Pain; Adult; Animals; Female; Humans; Male; Mental Disorders; Nervous System Diseases; Porphyria, Acute Intermittent; Porphyrias; Prognosis; Vomiting; Young Adult
PubMed: 32914723
DOI: 10.2174/1871525718666200910162000 -
Sports Medicine - Open Sep 2022The implementation of blood flow restriction (BFR) during exercise is becoming an increasingly useful adjunct method in both athletic and rehabilitative settings....
BACKGROUND
The implementation of blood flow restriction (BFR) during exercise is becoming an increasingly useful adjunct method in both athletic and rehabilitative settings. Advantages in pairing BFR with training can be observed in two scenarios: (1) training at lower absolute intensities (e.g. walking) elicits adaptations akin to high-intensity sessions (e.g. running intervals); (2) when performing exercise at moderate to high intensities, higher physiological stimulus may be attained, leading to larger improvements in aerobic, anaerobic, and muscular parameters. The former has been well documented in recent systematic reviews, but consensus on BFR (concomitant or post-exercise) combined with high-intensity interval training (HIIT) protocols is not well established. Therefore, this systematic review evaluates the acute and chronic effects of BFR + HIIT.
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to identify relevant studies. A systematic search on 1 February 2022, was conducted on four key databases: ScienceDirect, PubMed, Scopus and SPORTDiscus. Quality of each individual study was assessed using the Physiotherapy Evidence Database (PEDro) scale. Extraction of data from included studies was conducted using an adapted version of the 'Population, Intervention, Comparison, Outcome' (PICO) framework.
RESULTS
A total of 208 articles were identified, 18 of which met inclusion criteria. Of the 18 BFR + HIIT studies (244 subjects), 1 reported both acute and chronic effects, 5 examined acute responses and 12 investigated chronic effects. Acutely, BFR challenges the metabolic processes (vascular and oxygenation responses) during high-intensity repeated sprint exercise-which accelerates central and peripheral neuromuscular fatigue mechanisms resulting in performance impairments. Analysis of the literature exploring the chronic effects of BFR + HIIT suggests that BFR does provide an additive physiological training stimulus to HIIT protocols, especially for measured aerobic, muscular, and, to some extent, anaerobic parameters.
CONCLUSION
Presently, it appears that the addition of BFR into HIIT enhances physiological improvements in aerobic, muscular, and, to some extent, anaerobic performance. However due to large variability in permutations of BFR + HIIT methodologies, it is necessary for future research to explore and recommend standardised BFR guidelines for each HIIT exercise type.
PubMed: 36178530
DOI: 10.1186/s40798-022-00506-y -
The American Journal of Medicine Mar 2015Acute kidney injury complicates decompensated heart failure in ∼33% of cases and is associated with morbidity and mortality; thus, we sought to systematically review... (Review)
Review
BACKGROUND
Acute kidney injury complicates decompensated heart failure in ∼33% of cases and is associated with morbidity and mortality; thus, we sought to systematically review this topic in order to summarize novel diagnostic and therapeutic approaches.
METHODS
Structured PubMed searches on these topics were conducted in February 2014 and relevant literature was identified. The PubMed search identified a total of 192 articles that were individually screened for inclusion in this analysis, and 58 were included.
RESULTS
Acute kidney injury, defined by substantial increases in serum creatinine, is associated consistently with prolonged length of stay, rehospitalization, and mortality. Biomarker studies suggested that natriuretic peptides are prognostic for shorter- and longer-term mortality. Novel proteins indicating kidney damage and albumin in the urine are associated with acute kidney injury. The most promising acute pharmacologic treatment appears to be serelaxin, which has been shown to improve acute heart failure symptoms, hemodynamic parameters, and renal function.
CONCLUSIONS
The presence of acute kidney injury results in worse clinical outcomes for patients with acute heart failure. Novel biomarkers and therapies hold the promise of improving both cardiac and renal outcomes in these patients.
Topics: Acute Kidney Injury; Biomarkers; Cardiovascular Agents; Creatinine; Heart Failure; Hemodynamics; Hospitalization; Humans; Kidney Function Tests; Natriuretic Peptides; Prognosis; Recombinant Proteins; Relaxin; Treatment Outcome
PubMed: 25446297
DOI: 10.1016/j.amjmed.2014.10.035 -
In Vivo (Athens, Greece) 2016This article reviews epidemiology, risk factors and treatment modalities of postsurgical hypoparathyroidism (PHypo). PHypo occurs after total thyroidectomy due to injury... (Review)
Review
This article reviews epidemiology, risk factors and treatment modalities of postsurgical hypoparathyroidism (PHypo). PHypo occurs after total thyroidectomy due to injury of parathyroid glands and/or their blood supply or after parathyroidectomy. PHypo results in hypocalcemia because parathyroid hormone (PTH) secretion is impaired and cannot mobilize calcium from bone, reabsorb calcium from the distal nephron and stimulate renal 1α-hydroxylase activity. It usually appears in the first days after surgery and it can be symptomatic or asymptomatic. Risk factors are low level of intraoperative PTH and presence of parathyroid gland in the pathological specimen. Patients usually present with paresthesia, cramps or tetany, but the disorder may also manifest acutely with seizures, bronchospasm, laryngospasm or cardiac rhythm disturbances. Standard treatment is vitamin D analogues and calcium supplementation.
Topics: Calcium; Humans; Hypoparathyroidism; Parathyroid Glands; Parathyroid Hormone; Parathyroidectomy; Postoperative Complications; Thyroidectomy; Vitamin D; Vitamins
PubMed: 27107072
DOI: No ID Found -
Burns : Journal of the International... Aug 2022Delirium is a potentially modifiable, acutely altered mental state, commonly characterised as a hospital-acquired complication. Studies of adult inpatients with acute... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Delirium is a potentially modifiable, acutely altered mental state, commonly characterised as a hospital-acquired complication. Studies of adult inpatients with acute burns with and without delirium identify causative risks related to the injury or treatment and outcomes related to the patient and healthcare system. We compare patients with and without delirium, providing a high-level quantitative synthesis of delirium risks and outcomes to inform guidelines and future research.
METHODS
A systematic review, meta-analysis and GRADE evaluation of risks and outcomes associated with delirium in adults with acute burns was conducted using PRISMA guidelines and PROSPERO protocol CRD42021283055. The Newcastle-Ottawa Scale was used to assess quality.
RESULTS
Investigators reviewed ten studies. ASA score ≥ 3, Total Body Surface Area Percentage (TBSA)> 10%, surgery done, ICU admission, hospital and also Intensive Care Unit (ICU) lengths of stay all had statistically significant associations with delirium, with low-very low certainty on GRADE evaluation. Limitations were heterogeneous studies, review methodology and study bias.
CONCLUSION
Delirium represents a significant risk to comorbid patients with burns that are hospitalised, receive ICU care, and surgery. Further research is indicated to precisely categorise delirium along the clinical journey to identify modifiable factors, prevention, and proactive therapy.
Topics: Adult; Burns; Delirium; Humans; Inpatients; Intensive Care Units
PubMed: 35701326
DOI: 10.1016/j.burns.2022.05.023 -
Arquivos Brasileiros de Cirurgia... 2015Late acute rejection leads to worse patient and graft survival after liver transplantation. (Review)
Review
INTRODUCTION
Late acute rejection leads to worse patient and graft survival after liver transplantation.
AIM
To analyze the reported results published in recent years by leading transplant centers in evaluating late acute rejection and update the clinical manifestations, diagnosis and treatment of liver transplantation.
METHOD
Systematic literature review through Medline-PubMed database with headings related to late acute rejection in articles published until November 2013 was done. Were analyzed demographics, immunosuppression, rejection, infection and graft and patient survival rates.
RESULTS
Late acute rejection in liver transplantation showed poor results mainly regarding patient and graft survival. Almost all of these cohort studies were retrospective and descriptive. The incidence of late acute rejection varied from 7-40% in these studies. Late acute rejection was one cause for graft loss and resulted in different outcomes with worse patient and graft survival after liver transplant. Late acute rejection has been variably defined and may be a cause of chronic rejection with worse prognosis. Late acute rejection occurs during a period in which the goal is to maintain lower immunosuppression after liver transplantation.
CONCLUSION
The current articles show the importance of late acute rejection. The real benefit is based on early diagnosis and adequate treatment at the onset until late follow up after liver transplantation.
Topics: Acute Disease; Graft Rejection; Humans; Liver Transplantation; Time Factors
PubMed: 26537150
DOI: 10.1590/S0102-67202015000300017 -
Biology Sep 2021To summarize the evidence regarding the acute and chronic effects of interval training (IT) in the immune system through a systematic review with meta-analysis. (Review)
Review
PURPOSE
To summarize the evidence regarding the acute and chronic effects of interval training (IT) in the immune system through a systematic review with meta-analysis.
DESIGN
Systematic review with meta-analysis.
DATA SOURCE
English, Portuguese and Spanish languages search of the electronic databases Pubmed/Medline, Scopus, and SciELO. Eligibility criteria: Studies such as clinical trials, randomized cross-over trials and randomized clinical trials, investigating the acute and chronic effects of IT on the immune outcomes in humans.
RESULTS
Of the 175 studies retrieved, 35 were included in the qualitative analysis and 18 in a meta-analysis. Within-group analysis detected significant acute decrease after IT on immunoglobulin A (IgA) secretory rate ( = 115; MD = -15.46 µg·min; 95%CI, -28.3 to 2.66; = 0.02), total leucocyte count increase ( = 137; MD = 2.58 × 10 µL; 95%CI, 1.79 to 3.38; < 0.001), increase in lymphocyte count immediately after exercise ( = 125; MD = 1.3 × 10 µL; 95%CI, 0.86 to 1.75; < 0.001), and decrease during recovery (30 to 180 min post-exercise) ( = 125; MD = -0.36 × 10 µL;-0.57 to -0.15; < 0.001). No effect was detected on absolute IgA ( = 127; MD = 47.5 µg·mL; 95%CI, -10.6 to 105.6; = 0.11). Overall, IT might acutely reduce leucocyte function. Regarding chronic effects IT improved immune function without change leucocyte count.
CONCLUSION
IT might provide a transient disturbance on the immune system, followed by reduced immune function. However, regular IT performance induces favorable adaptations on immune function.
PubMed: 34571745
DOI: 10.3390/biology10090868 -
International Journal of Environmental... Feb 2021Athletes must distribute their attention to many relevant cues during a match. Therefore, athletes' ability to deal with dual-tasks may be different from the non-athlete... (Review)
Review
Athletes must distribute their attention to many relevant cues during a match. Therefore, athletes' ability to deal with dual-tasks may be different from the non-athlete population, demanding a deeper investigation within the sports domain. This study aimed to systematically review the acute and chronic effects of dual-tasks in motor and cognitive performances in athletes from different modalities. The search for articles followed all the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The keywords used were: "dual-task" OR "double task" OR "multi-task" OR "divided attention" OR "secondary task" OR "second task" AND "working memory" OR "visual" OR "decision making" OR "gaze behavior" OR "attention" AND "sports" OR "athletes" OR "players". The Scopus, Pubmed, and Web of Science databases were screened for studies comparing single and dual-tasks, in which the participants were athletes competing at any level, and in which at least one of the following variables were investigated: working memory, decision-making, visual search behavior, perception, anticipation, attention, or motor tasks. Articles were screened using pre-defined selection criteria, and methodological quality was assessed by two researchers independently. Following the eligibility criteria, we included 18 articles in the review: 13 on the acute effects, and five on the chronic effects. This review showed that the acute effect of dual-tasks impairs the motor and cognitive performances of athletes (dual-task cost). However, training with dual-tasks (chronic effect) improved working memory skills and attentional control. We conclude that dual-tasks acutely and chronically impacts motor and cognitive performance.
Topics: Athletes; Cognition; Humans; Memory, Short-Term
PubMed: 33579018
DOI: 10.3390/ijerph18041732 -
Brain : a Journal of Neurology Apr 2021Deep brain stimulation (DBS) of the subthalamic nucleus, pallidum, and thalamus is an established therapy for various movement disorders. Limbic targets have also been...
Deep brain stimulation (DBS) of the subthalamic nucleus, pallidum, and thalamus is an established therapy for various movement disorders. Limbic targets have also been increasingly explored for their application to neuropsychiatric and cognitive disorders. The brainstem constitutes another DBS substrate, although the existing literature on the indications for and the effects of brainstem stimulation remains comparatively sparse. The objective of this review was to provide a comprehensive overview of the pertinent anatomy, indications, and reported stimulation-induced acute and long-term effects of existing white and grey matter brainstem DBS targets. We systematically searched the published literature, reviewing clinical trial articles pertaining to DBS brainstem targets. Overall, 164 studies describing brainstem DBS were identified. These studies encompassed 10 discrete structures: periaqueductal/periventricular grey (n = 63), pedunculopontine nucleus (n = 48), ventral tegmental area (n = 22), substantia nigra (n = 9), mesencephalic reticular formation (n = 7), medial forebrain bundle (n = 8), superior cerebellar peduncles (n = 3), red nucleus (n = 3), parabrachial complex (n = 2), and locus coeruleus (n = 1). Indications for brainstem DBS varied widely and included central neuropathic pain, axial symptoms of movement disorders, headache, depression, and vegetative state. The most promising results for brainstem DBS have come from targeting the pedunculopontine nucleus for relief of axial motor deficits, periaqueductal/periventricular grey for the management of central neuropathic pain, and ventral tegmental area for treatment of cluster headaches. Brainstem DBS has also acutely elicited numerous motor, limbic, and autonomic effects. Further work involving larger, controlled trials is necessary to better establish the therapeutic potential of DBS in this complex area.
Topics: Brain Stem; Deep Brain Stimulation; Humans
PubMed: 33313788
DOI: 10.1093/brain/awaa374 -
European Journal of Ageing Dec 2022Meeting the needs of acute geriatric patients is often challenging, and although evidence shows that older patients need tailored care, it is still unclear which...
UNLABELLED
Meeting the needs of acute geriatric patients is often challenging, and although evidence shows that older patients need tailored care, it is still unclear which interventions are most appropriate. The objective of this study is to systematically evaluate the hospital-wide acute geriatric models compared with conventional pathways. The design of the study includes hospital-wide geriatric-specific models characterized by components including patient-centered care, frequent medical review, early rehabilitation, early discharge planning, prepared environment, and follow-up after discharge. Primary and secondary outcomes were considered, including functional decline, activities of daily living (ADL), length-of-stay (LoS), discharge destination, mortality, costs, and readmission. A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A total of 20 studies reporting on 15 trials and acutely admitted patients with an average age of 79, complex conditions and comorbidities to acute geriatric-specific pathways ( = 13,595) were included. Geriatric-specific models were associated with lower costs (weighted mean difference, WMD = - $174.98, 95% CI = -$332.14 to - $17.82; = 0.03), and shorter LoS (WMD = - 1.11, 95% CI = - 1.39 to - 0.83; < 0.001). No differences were found in functional decline, ADL, mortality, case fatalities, discharge destination, or readmissions. Geriatric-specific models are valuable for improving patient and system-level outcomes. Although several interventions had positive results, further research is recommended to study hospital-wide geriatric-specific models.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s10433-022-00743-w.
PubMed: 36506680
DOI: 10.1007/s10433-022-00743-w