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Physiotherapy Canada. Physiotherapie... 2021A systematic review was conducted to investigate the effect of respiratory physiotherapy on mortality, quality of life, functional recovery, intensive care length of...
A systematic review was conducted to investigate the effect of respiratory physiotherapy on mortality, quality of life, functional recovery, intensive care length of stay, duration of ventilation, oxygenation, secretion clearance, and pulmonary mechanics for invasively ventilated adults with pneumonia. Five databases were searched for randomized trials published between January 1995 and November 2018. Study quality was assessed using a standardized Joanna Briggs Institute critical appraisal tool, and Review Manager software was used to pool the studies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the level of certainty of the evidence. A total of 14 studies of moderate quality included 251 subjects with pneumonia. Eight studies were pooled for meta-analysis. Interventions that increased inspiratory volume appeared to benefit secretion clearance by nearly 2 grams (mean difference [MD] 1.97; 95% CI: 0.80, 3.14; very low GRADE evidence) and increase static lung compliance immediately after treatment by more than 5 millilitres/centimetre H0 (MD 5.40 mL/cm HO; 95% CI: 2.37, 8.43; very low GRADE evidence) or by more than 6 millilitres/centimetre HO after a 20- to 30-minute delay (MD 6.86 mL/cm HO; 95% CI: 2.86, 10.86; very low GRADE evidence). No adverse events were found. Respiratory physiotherapy that increases tidal volume may benefit secretion clearance and lung compliance in invasively ventilated adults with pneumonia, but its impact on other outcomes, including mortality, length of stay, and other patient-centred outcomes, is unclear, and further research is required.
PubMed: 35106019
DOI: 10.3138/ptc-2019-0025 -
The Journal of Nutrition Aug 2017Two indexes exist to describe dietary inflammatory potential: an empirical dietary inflammatory pattern (EDIP) composed of food groups as reported on a food-frequency... (Comparative Study)
Comparative Study
Two indexes exist to describe dietary inflammatory potential: an empirical dietary inflammatory pattern (EDIP) composed of food groups as reported on a food-frequency questionnaire (FFQ) and a literature-derived dietary inflammatory index (DII) composed mainly of nutrients. We compared the ability of the 2 indexes to predict concentrations of inflammatory markers and hypothesized that the EDIP would be more predictive because it was derived on the basis of circulating inflammatory markers. Both EDIP and DII scores were calculated from FFQ data reported by 5826 women in the Nurses' Health Study II and 5227 men in the Health Professionals Follow-Up Study. We used multivariable-adjusted linear regression analyses to calculate relative differences in concentrations of 4 plasma inflammatory markers-C-reactive protein (CRP; milligrams per liter), interleukin 6 (IL-6; picograms per milliliter), tumor necrosis factor α receptor 2 (TNFαR2; picograms per milliliter), and adiponectin (nanograms per milliliter)-in quintiles of the dietary indexes. Spearman correlations between the EDIP and DII scores were modest ( = 0.29 and 0.21 for women and men, respectively; all < 0.0001). Higher scores on both dietary indexes were associated with higher concentrations of inflammatory markers, although they were associated with lower adiponectin concentrations and there was no association between the DII and adiponectin in men. For example, percentage differences in concentrations of biomarkers in quintile 5 generally were higher (lower for adiponectin) than in quintile 1 (for the EDIP and DII, respectively-women: CRP, +60% and +49%; IL-6, +23% and +21%; TNFαR2, +7% and +4%; adiponectin, -21% and -14%; men: CRP, +38% and +29%; IL-6, +14% and +24%; TNFαR2, +9% and +5%; adiponectin, -16% and -4%.) Despite design differences, the EDIP and DII both assess dietary inflammatory potential in men and women, with the EDIP showing a greater ability to predict concentrations of plasma inflammatory markers.
Topics: Adiponectin; Adult; Biomarkers; C-Reactive Protein; Diet; Feeding Behavior; Female; Food; Humans; Inflammation; Interleukin-6; Male; Middle Aged; Receptors, Tumor Necrosis Factor, Type II; Surveys and Questionnaires
PubMed: 28659407
DOI: 10.3945/jn.117.248377 -
Critical Care Medicine Oct 2015
Topics: Female; Humans; Lung Diseases; Male; Respiration, Artificial
PubMed: 26376257
DOI: 10.1097/CCM.0000000000001234 -
Archives of Medical Science : AMS 2020Infection with hepatitis C virus (HCV) is a major health problem worldwide. A large proportion of perinatal HCV infections are silent and may present later in adulthood...
Infection with hepatitis C virus (HCV) is a major health problem worldwide. A large proportion of perinatal HCV infections are silent and may present later in adulthood with long-term complications. HCV has no effective immune prophylaxis and hence appropriate follow-up of all infants born to HCV-infected mothers is necessary. Universal antenatal screening for HCV is largely debatable. Intrauterine and partum transmission of HCV are both possible and higher rates are associated with a high maternal serum viral load (> 10 copies per milliliter), concomitant HIV infection, prolonged or difficult delivery, and invasive fetal monitoring during delivery. Infection during pregnancy and infancy needs to be investigated more in order to design management strategies for perinatal transmission of HCV most effectively. The recently approved new-generation, oral, direct-acting antiviral drugs may open a new era in HCV therapy for pregnant women and infected infants if proved to be safe during conception and infancy.
PubMed: 33224335
DOI: 10.5114/aoms.2019.83644 -
The World Allergy Organization Journal Jan 2021Current literature is inconsistent regarding the risk of severe side effects using accelerated induction protocols in Hymenoptera venom immunotherapy (VIT). In addition,...
BACKGROUND
Current literature is inconsistent regarding the risk of severe side effects using accelerated induction protocols in Hymenoptera venom immunotherapy (VIT). In addition, several data indicate the influence of purity grade of venom preparation on tolerability. We evaluated the safety and tolerability of ultra-rush and rush build-up protocols using purified and non-purified venom preparations.
METHODS
Retrospective single-center study of 581 VIT inductions (325 ultra-rush and 256 rush protocols) from 2005 to 2018 in 559 patients with bee and vespid venom allergy using aqueous purified (ALK SQ®) for ultra-rush protocol and aqueous non-purified (ALK Reless®) venom preparations for rush protocol.
RESULTS
Urticaria (8% vs. 3.1%, p = 0,013) and dose reductions (4.3% vs. 1.2%, p = 0,026) were significantly more frequent in the ultra-rush group. Overall rate of moderate-to-severe side effects (anaphylaxis grade 2 according to ) was low and did not differ significantly between protocols (p = 0.105). Severe events (grade 4 anaphylaxis) were not reported. Discontinuation rate was very low in both cohorts (0.6% vs 1.2%). The higher purity grade of venom preparations in the ultra-rush cohort did not improve tolerability. The bee venom group showed a non-significant trend towards higher incidence of mild reactions (urticaria), resulting in more frequent dose reductions and antiallergic therapy.
CONCLUSION
Rush and ultra-rush protocols show an excellent safety profile with only infrequent and mild anaphylactic reactions in bee and vespid venom allergy. Ultra-rush immunotherapy reduces the duration of the inpatient build-up phase setting and thus is viewed by the authors as preferred treatment in Hymenoptera venom allergic patients.
PubMed: 33376576
DOI: 10.1016/j.waojou.2020.100496 -
Journal of Cannabis Research Jul 2021Whether recreational cannabis legalization is associated with changes in alcohol consumption (suggesting a potential substitution or complementary relationship) is a key...
BACKGROUND
Whether recreational cannabis legalization is associated with changes in alcohol consumption (suggesting a potential substitution or complementary relationship) is a key question as cannabis policy evolves, particularly given the adverse health and social effects of alcohol use. Relatively little research has explored this question.
METHODS
This study examined the association between recreational cannabis legalization and alcohol purchasing in the USA using an interrupted time series design. We used data from the Nielsen Consumer Panel (2004-2017) from 69,761 households in all 50 states to calculate monthly milliliters of pure ethanol purchased for four beverage categories (beer, wine, spirits, and all alcohol products). We used difference-in-differences models and robust cluster standard errors to compare changes in milliliters of pure ethanol purchased. We fit models for each beverage category, comparing three "policy" states that have legalized recreational cannabis (Colorado, Oregon, and Washington) to states that had not legalized recreational cannabis. In one set of models, a single control state was selected that matched pre-policy purchasing trends in the policy states. In another set, policy states were compared to all states that had not legalized recreational cannabis.
RESULTS
Compared to all other states that did not legalize recreational cannabis, Colorado households showed a 13% average monthly decrease in purchases of all alcoholic products combined (estimate, 0.87; CI, 0.77, 0.98) and a 6% decrease in wine (0.94; CI, 0.89, 0.99). Estimates in Washington were suggestive of an increase in spirits purchased in both the unrestricted (1.24; CI, 1.12, 1.37) and restricted sample (1.18; CI, 1.02, 1.36). Oregon showed a significant decrease in monthly spirits purchased when compared to its selected comparator state (0.87; CI, 0.77, 0.99) and to all other states without legalized recreational cannabis (0.85; CI, 0.77, 0.95).
CONCLUSIONS
Results suggest that alcohol and cannabis are not clearly substitutes nor complements to one-another. Future studies should examine additional states as more time passes and more post-legalization data becomes available, use cannabis purchase data and consider additional methods for control selection in quasi-experimental studies.
PubMed: 34233755
DOI: 10.1186/s42238-021-00085-x -
Environmental Health Perspectives Feb 2022During the 2010 () disaster, controlled burning was conducted to remove oil from the water. Workers near combustion sites were potentially exposed to increased fine...
BACKGROUND
During the 2010 () disaster, controlled burning was conducted to remove oil from the water. Workers near combustion sites were potentially exposed to increased fine particulate matter [with aerodynamic diameter ()] levels. Exposure to has been linked to decreased lung function, but to our knowledge, no study has examined exposure encountered in an oil spill cleanup.
OBJECTIVE
We investigated the association between estimated only from burning/flaring of oil/gas and lung function measured 1-3 y after the disaster.
METHODS
We included workers who participated in response and cleanup activities on the water during the disaster and had lung function measured at a subsequent home visit (). concentrations were estimated using a Gaussian plume dispersion model and linked to work histories via a job-exposure matrix. We evaluated forced expiratory volume in 1 s (FEV1; milliliters), forced vital capacity (FVC; milliliters), and their ratio (FEV1/FVC; %) in relation to average and cumulative daily maximum exposures using multivariable linear regressions.
RESULTS
We observed significant exposure-response trends associating higher cumulative daily maximum exposure with lower FEV1 () and FEV1/FVC (). In comparison with the referent group (workers not involved in or near the burning), those with higher cumulative exposures had lower FEV1 [, 95% confidence interval (CI): , 3.7] and FEV1/FVC (, 95% CI: , 0.2). We also saw nonsignificant reductions in FVC (high vs. referent: , 95% CI: , 77.6; ). Similar associations were seen for average daily maximum exposure. Inverse associations were also observed in analyses stratified by smoking and time from exposure to spirometry and when we restricted to workers without prespill lung disease.
CONCLUSIONS
Among oil spill workers, exposure to specifically from controlled burning of oil/gas was associated with significantly lower FEV1 and FEV1/FVC when compared with workers not involved in burning. https://doi.org/10.1289/EHP8930.
Topics: Air Pollutants; Environmental Exposure; Forced Expiratory Volume; Humans; Lung; Particulate Matter; Petroleum Pollution; Vital Capacity
PubMed: 35103485
DOI: 10.1289/EHP8930 -
The New England Journal of Medicine Jul 2010The association between aging-related testosterone deficiency and late-onset hypogonadism in men remains a controversial concept. We sought evidence-based criteria for...
BACKGROUND
The association between aging-related testosterone deficiency and late-onset hypogonadism in men remains a controversial concept. We sought evidence-based criteria for identifying late-onset hypogonadism in the general population on the basis of an association between symptoms and a low testosterone level.
METHODS
We surveyed a random population sample of 3369 men between the ages of 40 and 79 years at eight European centers. Using questionnaires, we collected data with regard to the subjects' general, sexual, physical, and psychological health. Levels of total testosterone were measured in morning blood samples by mass spectrometry, and free testosterone levels were calculated with the use of Vermeulen's formula. Data were randomly split into separate training and validation sets for confirmatory analyses.
RESULTS
In the training set, symptoms of poor morning erection, low sexual desire, erectile dysfunction, inability to perform vigorous activity, depression, and fatigue were significantly related to the testosterone level. Increased probabilities of the three sexual symptoms and limited physical vigor were discernible with decreased testosterone levels (ranges, 8.0 to 13.0 nmol per liter [2.3 to 3.7 ng per milliliter] for total testosterone and 160 to 280 pmol per liter [46 to 81 pg per milliliter] for free testosterone). However, only the three sexual symptoms had a syndromic association with decreased testosterone levels. An inverse relationship between an increasing number of sexual symptoms and a decreasing testosterone level was observed. These relationships were independently confirmed in the validation set, in which the strengths of the association between symptoms and low testosterone levels determined the minimum criteria necessary to identify late-onset hypogonadism.
CONCLUSIONS
Late-onset hypogonadism can be defined by the presence of at least three sexual symptoms associated with a total testosterone level of less than 11 nmol per liter (3.2 ng per milliliter) and a free testosterone level of less than 220 pmol per liter (64 pg per milliliter).
Topics: Activities of Daily Living; Adult; Age of Onset; Aged; Depression; Erectile Dysfunction; Europe; Fatigue; Health Surveys; Humans; Hypogonadism; Libido; Logistic Models; Male; Middle Aged; Prevalence; Surveys and Questionnaires; Testosterone
PubMed: 20554979
DOI: 10.1056/NEJMoa0911101 -
The New England Journal of Medicine Jul 1992Transplantation of pancreatic islets, rather than whole pancreas, has been introduced as a treatment for diabetes mellitus. We studied five patients ranging in age from...
BACKGROUND
Transplantation of pancreatic islets, rather than whole pancreas, has been introduced as a treatment for diabetes mellitus. We studied five patients ranging in age from 12 to 37 years who had severe chronic pancreatitis for which they underwent total pancreatectomy followed by isolation and hepatic transplantation of their own islets.
METHODS
All patients had remained insulin-independent for 1 to 7 1/2 years after transplantation. The numbers of islets transplanted ranged from 110,000 to 412,000. Islet function was assessed by measuring the plasma insulin responses to intravenous glucose and arginine and the plasma glucagon responses to hypoglycemia and arginine. In one patient, islet function was studied during catheterization of the hepatic vein, portal vein, and splenic artery and by analysis of a liver-biopsy specimen.
RESULTS
After transplantation, the mean (+/- SD) fasting plasma glucose concentration was 122 +/- 47 mg per deciliter (6.8 +/- 2.6 mmol per liter) and the hemoglobin A1c concentration was 6.0 +/- 0.8 percent in the five patients. The values were most abnormal--214 mg per deciliter (11.9 mmol per liter) and 7.3 percent, respectively--in the patient who received only 110,000 islets. The acute plasma insulin responses to glucose and to arginine in the five patients were 23 +/- 13 and 26 +/- 10 microU per milliliter (168 +/- 94 and 184 +/- 70 pmol per liter), respectively, as compared with 58 +/- 6 and 37 +/- 8 microU per milliliter (416 +/- 44 and 267 +/- 61 pmol per liter) in the normal subjects. The peak plasma glucagon responses to insulin and arginine were 21 +/- 4 and 65 +/- 36 pg per milliliter, respectively, as compared with 125 +/- 28 and 156 +/- 99 pg per milliliter in the normal subjects. All five patients had plasma epinephrine but not pancreatic polypeptide responses to hypoglycemia. The results of the hepatic-vein catheterization in one patient indicated that the transplanted islets released insulin and glucagon in response to arginine. Immunoperoxidase staining of this patient's liver-biopsy specimen showed that the islets contained insulin, glucagon, and somatostatin but not pancreatic polypeptide.
CONCLUSIONS
Intrahepatic transplantation of as few as 265,000 islets can result in the release of insulin and glucagon at appropriate times and in prolonged periods of insulin independence.
Topics: Adolescent; Adult; Arginine; Blood Glucose; Chronic Disease; Female; Glucagon; Glucose; Glycated Hemoglobin; Humans; Hypoglycemia; Insulin; Insulin Secretion; Islets of Langerhans; Islets of Langerhans Transplantation; Liver; Male; Pancreatectomy; Pancreatic Polypeptide; Pancreatitis; Transplantation, Autologous
PubMed: 1614463
DOI: 10.1056/NEJM199207233270402 -
JSES Open Access Oct 2017There is convincing evidence supporting the prophylactic use of intrawound vancomycin powder in spinal fusion surgery and mounting evidence in the arthroplasty...
BACKGROUND
There is convincing evidence supporting the prophylactic use of intrawound vancomycin powder in spinal fusion surgery and mounting evidence in the arthroplasty literature suggesting that it can reduce surgical site infections. As a result, a number of shoulder arthroplasty surgeons have adopted this practice, despite a paucity of evidence and the presence of a pathogen that is, for the most part, unique to this area of the body-. The purpose of this study was to evaluate the efficacy of vancomycin against planktonic in vitro, using time-dependent concentrations one would expect in vivo after intra-articular application.
METHODS
Intrawound vancomycin concentrations were interpolated and extrapolated from existing in vivo data. Planktonic was then subjected to a time-kill analysis during 96 hours. At each time point, the inoculum was centrifuged into pellet form and then reconstituted for serial drop counts onto blood agar plates. After anaerobic incubation, colony-forming units were counted, and log colony-forming units per milliliter were determined.
RESULTS
Early time points grew to confluence, and thus colony-forming units per milliliter were not calculated. However, at 12 hours of vancomycin treatment, distinct colonies were appreciated. Notably, there was a 3 × log reduction in colony-forming units per milliliter between 12 and 48 hours, denoting bactericidal activity. In addition, was completely eradicated after 3 days of treatment.
CONCLUSION
When administered in a fashion meant to simulate time-dependent in vivo intrawound concentrations, vancomycin exhibited bactericidal activity against . This may lend credence to the prophylactic use of vancomycin in shoulder surgery.
PubMed: 30675553
DOI: 10.1016/j.jses.2017.08.001