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[PMID]:29318369
[Au] Autor:Janikova A; Bortlicek Z; Campr V; Kopalova N; Benesova K; Hamouzova M; Belada D; Prochazka V; Pytlik R; Vokurka S; Pirnos J; Duras J; Mocikova H; Mayer J; Trneny M
[Ad] Endereço:Department of Internal Medicine-Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic. janikova.andrea@fnbrno.cz.
[Ti] Título:The incidence of biopsy-proven transformation in follicular lymphoma in the rituximab era. A retrospective analysis from the Czech Lymphoma Study Group (CLSG) database.
[So] Source:Ann Hematol;97(4):669-678, 2018 Apr.
[Is] ISSN:1432-0584
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:The aim of this study is to assess the incidence, risk factors, and outcome of biopsy-proven transformation in follicular lymphoma (FL) patients in the rituximab era. Transformation was analyzed in 1233 patients with initially diagnosed FL grades 1-3A, identified between 2002 and 2012 in the prospectively maintained Czech Lymphoma Study Group database. Only patients with histologically proven transformation (HT) were included. HT occurred in 58 cases at a median of 3.0 years from the initial FL diagnosis; the HT rate was 4% at 5 years. Transformation occurred most frequently at the first relapse (84% patients). Median OS from the HT was 2.5 years (95% CI 0.4-4.6) and 6-year OS with HT was shorter compared to all FLs (60 vs. 83.9%; 95% CI). A bulky tumor (≥ 10 cm), increased lactate dehydrogenase, age ≥ 60 years, and International Prognostic Index (intermediate/high risk), but not Follicular Lymphoma International Prognostic Index, were associated with transformation (p < 0.05). In the first line, 70% of patients received rituximab (including 36% rituximab maintenance), 57% CHOP-like regimens, and 2.6% of patients were treated with fludarabine-based therapy, whereas 11% of patients were watched only. The patients treated with R-CHOP in the first line (n = 591) showed the transformation rate at 5 years of 4.23% (95% CI 2.52-5.93); subsequent rituximab maintenance (n = 276) vs. observation (n = 153) was associated with a lower transformation rate (p.033; HR 3.29; CI 1.10-9.82). The transformation rate seems to be lower than in previous series, which may be influenced by broad use of rituximab, but prognosis of HT developed during therapy continues to be poor.
[Mh] Termos MeSH primário: Antineoplásicos Imunológicos/uso terapêutico
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
Transformação Celular Neoplásica/efeitos dos fármacos
Linfoma Folicular/tratamento farmacológico
Rituximab/uso terapêutico
[Mh] Termos MeSH secundário: Adulto
Idoso
Antraciclinas/efeitos adversos
Antraciclinas/uso terapêutico
Antineoplásicos Imunológicos/efeitos adversos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos
Biópsia
Transformação Celular Neoplásica/patologia
Estudos de Coortes
República Tcheca/epidemiologia
Feminino
Seguimentos
Seres Humanos
Incidência
Linfoma Folicular/epidemiologia
Linfoma Folicular/patologia
Linfoma Folicular/prevenção & controle
Quimioterapia de Manutenção/efeitos adversos
Masculino
Meia-Idade
Sistema de Registros
Estudos Retrospectivos
Rituximab/efeitos adversos
Prevenção Secundária
Análise de Sobrevida
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anthracyclines); 0 (Antineoplastic Agents, Immunological); 4F4X42SYQ6 (Rituximab)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180111
[St] Status:MEDLINE
[do] DOI:10.1007/s00277-017-3218-0


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[PMID]:29280370
[Au] Autor:Wozniak A; Krótki M; Anyzewska A; Górnicka M; Wawrzyniak A
[Ad] Endereço:Department of Human Nutrition, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences (SGGW - WULS), Warsaw, Poland
[Ti] Título:Adherence to nutrition guidelines in patients with cardiovascular diseases (CVD) as a secondary prevention
[So] Source:Rocz Panstw Zakl Hig;68(4):401-407, 2017.
[Is] ISSN:0035-7715
[Cp] País de publicação:Poland
[La] Idioma:eng
[Ab] Resumo:Background: The appropriate nutrition is an important component of the secondary prevention of cardiovascular diseases (CVD) Objectives: The aim of the study was to investigate if the patients with cardiovascular disease were informed of the role of appropriate nutrition in prevention or received nutrition guidelines and to assess the dietary intake compared to recommendations for patients with cardiovascular disease who received or not nutrition guidelines Material and Methods: The study was conducted among patients with cardiovascular disease (n = 127) of cardiological hospital clinic, aged 62 ± 11. The questionnaire was used to obtain personal and anthropometric details, information if patients had received nutrition guidelines. The method of 3-day food records was used for dietary assessment Results: 20% of subjects had not received nutrition guidelines and almost 40% of subjects did not recognize the nutrition effect on cardiovascular disease development. Compared to the diets of the subjects who had not received nutrition guidelines, the diets of those who had received them were of significantly lower intake of: energy from saturated fatty acids (15%, p = 0.006), cholesterol (21%, p = 0.012) and higher intake (14-26%) of potassium (p = 0,003), sodium (p = 0.013), phosphorus (p = 0.044), magnesium (p = 0.003), iron (p = 0.005), copper (p = 0.001), zinc (p = 0.046). Among the patients who had received nutrition guidelines, percentage of the subjects whose intake of nutrients was consistent with recommendations was higher Conclusions: Not all subjects had received nutrition guidelines. Diets of those who had received them were more balanced, but in neither group nutrition guidelines were complied with
[Mh] Termos MeSH primário: Doenças Cardiovasculares/prevenção & controle
Dieta/psicologia
Comportamento Alimentar/psicologia
Cooperação do Paciente/psicologia
Prevenção Secundária/métodos
[Mh] Termos MeSH secundário: Idoso
Feminino
Guias como Assunto
Seres Humanos
Masculino
Meia-Idade
Avaliação Nutricional
Estado Nutricional
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171228
[St] Status:MEDLINE


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[PMID]:29267500
[Au] Autor:Vieira E; Maia HS; Monteiro CB; Carvalho LM; Tonon T; Vanz AP; Schwartz IVD; Ribeiro MG
[Ad] Endereço:Agência Nacional de Saúde Suplementar, Rio de Janeiro, RJ, Brasil.
[Ti] Título:Quality of life and adherence to treatment in early-treated Brazilian phenylketonuria pediatric patients.
[So] Source:Braz J Med Biol Res;51(2):e6709, 2017 Dec 11.
[Is] ISSN:1414-431X
[Cp] País de publicação:Brazil
[La] Idioma:eng
[Ab] Resumo:Early dietary treatment of phenylketonuria (PKU), an inborn error of phenylalanine (Phe) metabolism, results in normal cognitive development. Although health-related quality of life (HRQoL) of PKU patients has been reported as unaffected in high-income countries, there are scarce data concerning HRQoL and adherence to treatment of PKU children and adolescents from Brazil. The present study compared HRQoL scores in core dimensions of Brazilian early-treated PKU pediatric patients with those of a reference population, and explored possible relationships between adherence to treatment and HRQoL. Early-treated PKU pediatric patient HRQoL was evaluated by self- and parent-proxy reports of the Pediatric Quality of Life Inventory (PedsQL) core scales. Adherence to treatment was evaluated by median Phe levels and percentage of results within the therapeutic target range in two periods. Means for total and core scales scores of PedsQL self- and parent proxy-reports of PKU patients were significantly lower than their respective means for controls. Adequacy of median Phe concentrations and the mean percentage of values in the target range fell substantially from the first year of life to the last year of this study. There was no significant difference in mean total and core scale scores for self- and parent proxy-reports between patients with adequate and those with inadequate median Phe concentrations. The harmful consequences for intellectual capacity caused by poor adherence to dietary treatment could explain the observed decrease in all HRQoL scales, especially in school functioning. Healthcare system and financial difficulties may also have influenced negatively all HRQoL dimensions.
[Mh] Termos MeSH primário: Fenilcetonúrias/dietoterapia
Qualidade de Vida
Cooperação e Adesão ao Tratamento/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Fatores Etários
Análise de Variância
Brasil
Criança
Feminino
Seres Humanos
Testes de Inteligência
Modelos Lineares
Masculino
Pais
Fenilalanina/sangue
Fenilcetonúrias/psicologia
Procurador
Qualidade de Vida/psicologia
Prevenção Secundária
Autorrelato
Fatores Socioeconômicos
Fatores de Tempo
Cooperação e Adesão ao Tratamento/psicologia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
47E5O17Y3R (Phenylalanine)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171222
[St] Status:MEDLINE


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[PMID]:29397593
[Au] Autor:Committee of Cardio-Cerebro-Vascular Diseases of Gerontological Society of China; Working Group of Chinese Expert Consensus on the Use of Xuezhikang
[Ti] Título:[Chinese expert consensus on the use of Xuezhikang (2017 revised edition)].
[So] Source:Zhonghua Nei Ke Za Zhi;57(2):97-100, 2018 Feb 01.
[Is] ISSN:0578-1426
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:Xuezhikang, a Chinese traditional medicine, contains natural statin and is effective on dyslipidemia by inhibiting cholesterol synthesis. Xuezhikang therapy for 8 weeks in patients with hyperlipidemia reduced total cholesterol (TC) by 23%, low density lipoprotein cholesterol (LDL-C) by 28.5% and triglyceride(TG) by 36.5%, and increased high density lipoprotein cholesterol (HDL-C) by 19.6%, respectively. Data from China Coronary Secondary Prevention Study (CCSPS) showed that treatment with Xuezhikang lowered the risks of major coronary events, death from coronary heart disease, and all cause death in patients with myocardial infarction, indicating that Xuezhikang can be used in the primary and secondary prevention of cardiovascular disease.
[Mh] Termos MeSH primário: Consenso
Medicamentos de Ervas Chinesas/uso terapêutico
Dislipidemias/tratamento farmacológico
Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico
[Mh] Termos MeSH secundário: Grupo com Ancestrais do Continente Asiático
Causas de Morte
China
LDL-Colesterol
Seres Humanos
Infarto do Miocárdio
Prevenção Secundária
Triglicerídeos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Cholesterol, LDL); 0 (Drugs, Chinese Herbal); 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors); 0 (Triglycerides); 0 (xuezhikang)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180206
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.0578-1426.2018.02.003


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[PMID]:29267415
[Au] Autor:Lecomte T; Corbière M
[Ad] Endereço:Département de psychologie, Université de Montréal; Centre de recherche, Institut universitaire en santé mentale de Montréal (CR-IUSMM).
[Ti] Título:[A Group Cognitive-Behavioural Intervention to Prevent Depression Relapse in Individuals Having Recently Returned to Work: Protocol and Feasibility].
[Ti] Título:Une intervention cognitive comportementale de groupe pour prévenir les rechutes chez les employés en processus de retour au travail à la suite d'une dépression : protocole et faisabilité..
[So] Source:Sante Ment Que;42(2):87-103, 2017.
[Is] ISSN:0383-6320
[Cp] País de publicação:Canada
[La] Idioma:fre
[Ab] Resumo:Workplace depression is one of the major causes for sick leave and loss of productivity at work. Many studies have investigated factors predicting return to work for people with depression, including studies evaluating return to work programs and organizational factors. Yet, a paucity of studies have targeted the prevention of depressive relapses at work, even though more than half of those having had a depression will have a depressive relapse in the near future.Objectives This article describes a research protocol involving a novel group intervention based on cognitive behavioural principles with the aim to optimize return to work and diminish risk of depressive relapses.Method This pilot study follows a randomized controlled trial design, with half the participants (N=25) receiving the group intervention and the other half (N=25) receiving usual services. The theoretical and empirical underpinnings of the intervention are described, along with a detailed presentation of the intervention and of the study's objectives. The group intervention consists of 8 sessions whereby Cognitive behavioural therapy (CBT) principles and techniques are applied to the following themes: (1) Coping with stress at work; (2) Recognizing and modifying my dysfunctional beliefs linked to work; (3) Overcoming obstacles linked to work functioning and maintaining work; (4) Negotiating needed work adjustments with the support of the immediate supervisor; (5) Finding my strengths and competencies related to work; (6) Accepting criticism and asserting myself appropriately at work; (7) Uncovering my best coping strategies for work.Results Qualitative information pertaining to the first two cohorts' participants' subjective appreciation of the group experience revealed that the intervention was perceived as very useful by all, with group support, namely harmony and interpersonal support, as well as CBT strategies being mentioned specifically.Conclusion Finally, the potential relevance of the group intervention will be brought forward.
[Mh] Termos MeSH primário: Terapia Cognitiva
Depressão/prevenção & controle
Psicoterapia de Grupo
Retorno ao Trabalho
Prevenção Secundária
[Mh] Termos MeSH secundário: Protocolos Clínicos
Estudos de Viabilidade
Seres Humanos
Projetos Piloto
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171222
[St] Status:MEDLINE


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[PMID]:29361618
[Au] Autor:Madoiwa S
[Ad] Endereço:Dept. of Clinical Laboratory Medicine, Tokyo Saiseikai Central Hospital.
[Ti] Título:[Management of Venous Thromboembolism in Cancer Patients].
[So] Source:Gan To Kagaku Ryoho;44(13):2064-2071, 2017 Dec.
[Is] ISSN:0385-0684
[Cp] País de publicação:Japan
[La] Idioma:jpn
[Ab] Resumo:The clinical relevance of the association between venous thromboembolism(VTE)and cancer is well documented. VTE is one of the leading causes of death in cancer patients. It would be an advantage to have knowledge on predictive parameters for the development of thrombosis and to be able to select cancer patients individually according to their riskprofiles. An elevated platelet count is associated with an increased riskof VTE in cancer patients. The biomarkers including D-dimer have been identified and used to extend the existing riskstratification. Treatment of VTE in cancer patients is complicated due to a high rate of recurrence in addition to a higher riskof bleeding during anticoagulation therapy. Current guidelines recommend low-molecular-weight heparin(LMWH)monotherapy over vitamin K antagonist(VKA)for the treatment of cancer-associated VTE. However, recent clinical study could not show any superior efficacy of LMWH over VKA in preventing VTE recurrence or overall mortality. The direct oral anticoagulants(DOACs)may be an effective treatment for VTE in cancer patients, although the riskreduction for recurrent VTE with the DOACs compared to LMWH has not been well assessed. Physicians should frequently re-evaluate the risk-benefit ratio of ongoing anticoagulation therapy in individual patient, in views of the overall clinical conditions including their quality of life and life expectancy.
[Mh] Termos MeSH primário: Neoplasias/complicações
Tromboembolia Venosa/tratamento farmacológico
[Mh] Termos MeSH secundário: Doença Aguda
Seres Humanos
Recidiva
Prevenção Secundária
Tromboembolia Venosa/etiologia
Tromboembolia Venosa/prevenção & controle
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180124
[St] Status:MEDLINE


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Registro de Ensaios Clínicos
Registro de Ensaios Clínicos
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[PMID]:29183074
[Au] Autor:Kao D; Roach B; Silva M; Beck P; Rioux K; Kaplan GG; Chang HJ; Coward S; Goodman KJ; Xu H; Madsen K; Mason A; Wong GK; Jovel J; Patterson J; Louie T
[Ad] Endereço:Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
[Ti] Título:Effect of Oral Capsule- vs Colonoscopy-Delivered Fecal Microbiota Transplantation on Recurrent Clostridium difficile Infection: A Randomized Clinical Trial.
[So] Source:JAMA;318(20):1985-1993, 2017 11 28.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Fecal microbiota transplantation (FMT) is effective in preventing recurrent Clostridium difficile infection (RCDI). However, it is not known whether clinical efficacy differs by route of delivery. Objective: To determine whether FMT by oral capsule is noninferior to colonoscopy delivery in efficacy. Design, Setting, and Participants: Noninferiority, unblinded, randomized trial conducted in 3 academic centers in Alberta, Canada. A total of 116 adult patients with RCDI were enrolled between October 2014 and September 2016, with follow-up to December 2016. The noninferiority margin was 15%. Interventions: Participants were randomly assigned to FMT by capsule or by colonoscopy at a 1:1 ratio. Main Outcomes and Measures: The primary outcome was the proportion of patients without RCDI 12 weeks after FMT. Secondary outcomes included (1) serious and minor adverse events, (2) changes in quality of life by the 36-Item Short Form Survey on a scale of 0 (worst possible quality of life) to 100 (best quality of life), and (3) patient perception on a scale of 1 (not at all unpleasant) to 10 (extremely unpleasant) and satisfaction on a scale of 1 (best) to 10 (worst). Results: Among 116 patients randomized (mean [SD] age, 58 [19] years; 79 women [68%]), 105 (91%) completed the trial, with 57 patients randomized to the capsule group and 59 to the colonoscopy group. In per-protocol analysis, prevention of RCDI after a single treatment was achieved in 96.2% in both the capsule group (51/53) and the colonoscopy group (50/52) (difference, 0%; 1-sided 95% CI, -6.1% to infinity; P < .001), meeting the criterion for noninferiority. One patient in each group died of underlying cardiopulmonary illness unrelated to FMT. Rates of minor adverse events were 5.4% for the capsule group vs 12.5% for the colonoscopy group. There was no significant between-group difference in improvement in quality of life. A significantly greater proportion of participants receiving capsules rated their experience as "not at all unpleasant" (66% vs 44%; difference, 22% [95% CI, 3%-40%]; P = .01). Conclusions and Relevance: Among adults with RCDI, FMT via oral capsules was not inferior to delivery by colonoscopy for preventing recurrent infection over 12 weeks. Treatment with oral capsules may be an effective approach to treating RCDI. Trial Registration: clinicaltrials.gov Identifier: NCT02254811.
[Mh] Termos MeSH primário: Administração Oral
Infecções por Clostridium/terapia
Colonoscopia
Transplante de Microbiota Fecal/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Cápsulas
Infecções por Clostridium/prevenção & controle
Transplante de Microbiota Fecal/efeitos adversos
Fezes/microbiologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Satisfação do Paciente
Qualidade de Vida
Prevenção Secundária
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; EQUIVALENCE TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Capsules)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171129
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.17077


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[PMID]:29363105
[Au] Autor:Hakoum MB; Kahale LA; Tsolakian IG; Matar CF; Yosuico VE; Terrenato I; Sperati F; Barba M; Schünemann H; Akl EA
[Ad] Endereço:Family Medicine, American University of Beirut, Beirut, Lebanon, 1107 2020.
[Ti] Título:Anticoagulation for the initial treatment of venous thromboembolism in people with cancer.
[So] Source:Cochrane Database Syst Rev;1:CD006649, 2018 01 24.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Compared with people without cancer, people with cancer who receive anticoagulant treatment for venous thromboembolism (VTE) are more likely to develop recurrent VTE. OBJECTIVES: To compare the efficacy and safety of three types of parenteral anticoagulants (i.e. fixed-dose low molecular weight heparin (LMWH), adjusted-dose unfractionated heparin (UFH), and fondaparinux) for the initial treatment of VTE in people with cancer. SEARCH METHODS: A comprehensive search included a major electronic search of the following databases: Cochrane Central Register of Controlled Trials (CENTRAL) (2018, Issue 1), MEDLINE (via Ovid) and Embase (via Ovid); handsearching of conference proceedings; checking of references of included studies; use of the 'related citation' feature in PubMed; and a search for ongoing studies. This update of the systematic review was based on the findings of a literature search conducted on 14 January 2018. SELECTION CRITERIA: Randomized controlled trials (RCTs) assessing the benefits and harms of LMWH, UFH, and fondaparinux in people with cancer and objectively confirmed VTE. DATA COLLECTION AND ANALYSIS: Using a standardized form, we extracted data in duplicate on study design, participants, interventions outcomes of interest, and risk of bias. Outcomes of interested included all-cause mortality, symptomatic VTE, major bleeding, minor bleeding, postphlebitic syndrome, quality of life, and thrombocytopenia. We assessed the certainty of evidence for each outcome using the GRADE approach. MAIN RESULTS: Of 15440 identified citations, 7387 unique citations, 15 RCTs fulfilled the eligibility criteria. These trials enrolled 1615 participants with cancer and VTE: 13 compared LMWH with UFH enrolling 1025 participants, one compared fondaparinux with UFH and LMWH enrolling 477 participants, and one compared dalteparin with tinzaparin enrolling 113 participants. The meta-analysis of mortality at three months included 418 participants from five studies and that of recurrent VTE included 422 participants from 3 studies. The findings showed that LMWH likely decreases mortality at three months compared to UFH (risk ratio (RR) 0.66, 95% confidence interval (CI) 0.40 to 1.10; risk difference (RD) 57 fewer per 1000, 95% CI 101 fewer to 17 more; moderate certainty evidence), but did not rule out a clinically significant increase or decrease in VTE recurrence (RR 0.69, 95% CI 0.27 to 1.76; RD 30 fewer per 1000, 95% CI 70 fewer to 73 more; moderate certainty evidence).The study comparing fondaparinux with heparin (UFH or LMWH) did not exclude a beneficial or detrimental effect of fondaparinux on mortality at three months (RR 1.25, 95% CI 0.86 to 1.81; RD 43 more per 1000, 95% CI 24 fewer to 139 more; moderate certainty evidence), recurrent VTE (RR 0.93, 95% CI 0.56 to 1.54; RD 8 fewer per 1000, 95% CI 52 fewer to 63 more; moderate certainty evidence), major bleeding (RR 0.82, 95% CI 0.40 to 1.66; RD 12 fewer per 1000, 95% CI 40 fewer to 44 more; moderate certainty evidence), or minor bleeding (RR 1.53, 95% CI 0.88 to 2.66; RD 42 more per 1000, 95% CI 10 fewer to 132 more; moderate certainty evidence)The study comparing dalteparin with tinzaparin did not exclude a beneficial or detrimental effect of dalteparin on mortality (RR 0.86, 95% CI 0.43 to 1.73; RD 33 fewer per 1000, 95% CI 135 fewer to 173 more; low certainty evidence), recurrent VTE (RR 0.44, 95% CI 0.09 to 2.16; RD 47 fewer per 1000, 95% CI 77 fewer to 98 more; low certainty evidence), major bleeding (RR 2.19, 95% CI 0.20 to 23.42; RD 20 more per 1000, 95% CI 14 fewer to 380 more; low certainty evidence), or minor bleeding (RR 0.82, 95% CI 0.30 to 2.21; RD 24 fewer per 1000, 95% CI 95 fewer to 164 more; low certainty evidence). AUTHORS' CONCLUSIONS: LMWH is possibly superior to UFH in the initial treatment of VTE in people with cancer. Additional trials focusing on patient-important outcomes will further inform the questions addressed in this review. The decision for a person with cancer to start LMWH therapy should balance the benefits and harms and consider the person's values and preferences.
[Mh] Termos MeSH primário: Anticoagulantes/uso terapêutico
Neoplasias/complicações
Tromboembolia Venosa/tratamento farmacológico
[Mh] Termos MeSH secundário: Dalteparina/uso terapêutico
Fibrinolíticos/uso terapêutico
Hemorragia/induzido quimicamente
Heparina/uso terapêutico
Heparina de Baixo Peso Molecular/uso terapêutico
Seres Humanos
Polissacarídeos/uso terapêutico
Ensaios Clínicos Controlados Aleatórios como Assunto
Recidiva
Prevenção Secundária
Tromboembolia Venosa/mortalidade
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Fibrinolytic Agents); 0 (Heparin, Low-Molecular-Weight); 0 (Polysaccharides); 7UQ7X4Y489 (tinzaparin); 9005-49-6 (Heparin); J177FOW5JL (fondaparinux); S79O08V79F (Dalteparin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180125
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD006649.pub7


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[PMID]:29315455
[Au] Autor:Othieno R; Okpo E; Forster R
[Ad] Endereço:NHS Lothian, Directorate of Public Health and Health Policy, Waverly Gate, 2-4 Waterloo Place, Edinburgh, UK, EH1 3EG.
[Ti] Título:Home versus in-patient treatment for deep vein thrombosis.
[So] Source:Cochrane Database Syst Rev;1:CD003076, 2018 01 09.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Deep vein thrombosis (DVT) occurs when a blood clot blocks blood flow through a vein, which can occur after surgery, after trauma, or when a person has been immobile for a long time. Clots can dislodge and block blood flow to the lungs (pulmonary embolism (PE)), causing death. DVT and PE are known by the term venous thromboembolism (VTE). Heparin (in the form of unfractionated heparin (UFH)) is a blood-thinning drug used during the first three to five days of DVT treatment. Low molecular weight heparins (LMWHs) allow people with DVT to receive their initial treatment at home instead of in hospital. This is an update of a review first published in 2001 and updated in 2007. OBJECTIVES: To compare the incidence and complications of venous thromboembolism (VTE) in patients treated at home versus patients treated with standard in-patient hospital regimens. Secondary objectives included assessment of patient satisfaction and cost-effectiveness of treatment. SEARCH METHODS: For this update, the Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register (last searched 16 March 2017), the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 2), and trials registries. We also checked the reference lists of relevant publications. SELECTION CRITERIA: Randomised controlled trials (RCTs) examining home versus hospital treatment for DVT, in which DVT was clinically confirmed and was treated with LMWHs or UFH. DATA COLLECTION AND ANALYSIS: One review author selected material for inclusion, and another reviewed the selection of trials. Two review authors independently extracted data and assessed included studies for risk of bias. Primary outcomes included combined VTE events (PE and recurrent DVT), gangrene, heparin complications, and death. Secondary outcomes were patient satisfaction and cost implications. We performed meta-analysis using fixed-effect models with risk ratios (RRs) and 95% confidence intervals (CIs) for dichotomous data. MAIN RESULTS: We included in this review seven RCTs involving 1839 randomised participants with comparable treatment arms. All seven had fundamental problems including high exclusion rates, partial hospital treatment of many in the home treatment arms, and comparison of UFH in hospital versus LMWH at home. These trials showed that patients treated at home with LMWH were less likely to have recurrence of VTE events than those given hospital treatment with UFH or LMWH (fixed-effect risk ratio (RR) 0.58, 95% confidence interval (CI) 0.39 to 0.86; 6 studies; 1708 participants; P = 0.007; low-quality evidence). No clear difference was seen between groups for major bleeding (RR 0.67, 95% CI 0.33 to 1.36; 6 studies; 1708 participants; P = 0.27; low-quality evidence), minor bleeding (RR 1.29, 95% CI 0.94 to 1.78; 6 studies; 1708 participants; P = 0.11; low-quality evidence), or mortality (RR 0.69, 95% CI 0.44 to 1.09; 6 studies; 1708 participants; P = 0.11; low-quality evidence). The included studies reported no cases of venous gangrene. We could not combine patient satisfaction and quality of life outcomes in meta-analysis owing to heterogeneity of reporting, but two of three studies found evidence that home treatment led to greater improvement in quality of life compared with in-patient treatment at some point during follow-up, and the third study reported that a large number of participants chose to switch from in-patient care to home-based care for social and personal reasons, suggesting it is the patient's preferred option (very low-quality evidence). None of the studies included in this review carried out a full cost-effectiveness analysis. However, a small randomised economic evaluation of the two alternative treatment settings involving 131 participants found that direct costs were higher for those in the in-patient group. These findings were supported by three other studies that reported on their costs (very low-quality evidence).Quality of evidence for data from meta-analyses was low to very low. This was due to risk of bias, as many of the included studies used unclear randomisation techniques, and blinding was a concern for many. Also, indirectness was a concern, as most studies included a large number of participants randomised to the home (LMWH) treatment group who were treated in hospital for some or all of the treatment period. A further issue for some outcomes was heterogeneity that was evident in measurement and reporting of outcomes. AUTHORS' CONCLUSIONS: Low-quality evidence suggests that patients treated at home with LMWH are less likely to have recurrence of VTE than those treated in hospital. However, data show no clear differences in major or minor bleeding, nor in mortality (low-quality evidence), indicating that home treatment is no worse than in-patient treatment for these outcomes. Because most healthcare systems are moving towards more LMWH usage in the home setting it is unlikely that additional large trials will be undertaken to compare these treatments. Therefore, home treatment is likely to become the norm, and further research will be directed towards resolving practical issues by devising local guidelines that include clinical prediction rules, developing biomarkers and imaging that can be used to tailor therapy to disease severity, and providing training for community healthcare workers who administer treatment and monitor treatment progress.
[Mh] Termos MeSH primário: Fibrinolíticos/uso terapêutico
Heparina/uso terapêutico
Serviços de Assistência Domiciliar
Hospitalização
Trombose Venosa/tratamento farmacológico
[Mh] Termos MeSH secundário: Análise Custo-Benefício
Hemorragia/induzido quimicamente
Heparina/efeitos adversos
Heparina de Baixo Peso Molecular/efeitos adversos
Heparina de Baixo Peso Molecular/uso terapêutico
Seres Humanos
Ensaios Clínicos Controlados Aleatórios como Assunto
Recidiva
Prevenção Secundária
Terapia Trombolítica/normas
Trombose Venosa/mortalidade
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Fibrinolytic Agents); 0 (Heparin, Low-Molecular-Weight); 9005-49-6 (Heparin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180110
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD003076.pub3


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[PMID]:27771154
[Au] Autor:Barbieri M; Marfella R; Esposito A; Rizzo MR; Angellotti E; Mauro C; Siniscalchi M; Chirico F; Caiazzo P; Furbatto F; Bellis A; D'Onofrio N; Vitiello M; Ferraraccio F; Paolisso G; Balestrieri ML
[Ad] Endereço:Department of Medical, Surgical, Neurological, Aging and Metabolic Sciences, Second University of Naples, Piazza Miraglia 2, 80138, Naples, Italy. Electronic address: michelangela.barbieri@unina2.it.
[Ti] Título:Incretin treatment and atherosclerotic plaque stability: Role of adiponectin/APPL1 signaling pathway.
[So] Source:J Diabetes Complications;31(2):295-303, 2017 Feb.
[Is] ISSN:1873-460X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:AIMS: Glucagon like peptide 1 (GLP-1) analogues and dipeptidyl peptidase IV (DPP-4) inhibitors reduce atherosclerosis progression in type 2 diabetes mellitus (T2DM) patients and are associated with morphological and compositional characteristics of stable plaque phenotype. GLP-1 promotes the secretion of adiponectin which exerts anti-inflammatory effects through the adaptor protein PH domain and leucine zipper containing 1 (APPL1). The potential role of APPL1 expression in the evolution of atherosclerotic plaque in TDM2 patients has not previously evaluated. METHODS: The effect of incretin therapy in the regulation of adiponectin/APPL1 signaling was evaluated both on carotid plaques of asymptomatic diabetic (n=71) and non-diabetic patients (n=52), and through in vitro experiments on endothelial cell (EC). RESULTS: Atherosclerotic plaques of T2DM patients showed lower adiponectin and APPL1 levels compared with non-diabetic patients, along with higher oxidative stress, tumor necrosis factor-α (TNF-α), vimentin, and matrix metalloproteinase-9 (MMP-9) levels. Among T2DM subjects, current incretin-users presented higher APPL1 and adiponectin content compared with never incretin-users. Similarly, in vitro observations on endothelial cells co-treated with high-glucose (25mM) and GLP-1 (100nM) showed a greater APPL1 protein expression compared with high-glucose treatment alone. CONCLUSIONS: Our findings suggest a potential role of adiponectin/APPL1 signaling in mediating the effect of incretin in the prevention of atherosclerosis progression or plaque vulnerability in T2DM.
[Mh] Termos MeSH primário: Proteínas Adaptadoras de Transdução de Sinal/agonistas
Adiponectina/metabolismo
Diabetes Mellitus Tipo 2/tratamento farmacológico
Angiopatias Diabéticas/prevenção & controle
Incretinas/uso terapêutico
Placa Aterosclerótica/prevenção & controle
Transdução de Sinais/efeitos dos fármacos
[Mh] Termos MeSH secundário: Proteínas Adaptadoras de Transdução de Sinal/metabolismo
Idoso
Anti-Inflamatórios não Esteroides/farmacologia
Anti-Inflamatórios não Esteroides/uso terapêutico
Antioxidantes/farmacologia
Antioxidantes/uso terapêutico
Estenose das Carótidas/complicações
Estenose das Carótidas/epidemiologia
Estenose das Carótidas/prevenção & controle
Estenose das Carótidas/cirurgia
Células Cultivadas
Diabetes Mellitus Tipo 2/complicações
Diabetes Mellitus Tipo 2/metabolismo
Diabetes Mellitus Tipo 2/patologia
Angiopatias Diabéticas/epidemiologia
Angiopatias Diabéticas/patologia
Angiopatias Diabéticas/cirurgia
Endarterectomia das Carótidas
Endotélio Vascular/efeitos dos fármacos
Endotélio Vascular/imunologia
Endotélio Vascular/metabolismo
Endotélio Vascular/patologia
Feminino
Peptídeo 1 Semelhante ao Glucagon/metabolismo
Seres Humanos
Incretinas/farmacologia
Itália/epidemiologia
Masculino
Estresse Oxidativo/efeitos dos fármacos
Placa Aterosclerótica/complicações
Placa Aterosclerótica/epidemiologia
Placa Aterosclerótica/patologia
Fatores de Risco
Prevenção Secundária
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (ADIPOQ protein, human); 0 (APPL1 protein, human); 0 (Adaptor Proteins, Signal Transducing); 0 (Adiponectin); 0 (Anti-Inflammatory Agents, Non-Steroidal); 0 (Antioxidants); 0 (Incretins); 89750-14-1 (Glucagon-Like Peptide 1)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE



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