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Effectiveness of Two Exercise Training Programs in Patients with Chronic Obstructive Pulmonary Disease
Angela Maria Pereira,
Ernesto Pereira,
Sónia Vicente,
Helena Santa-Clara
Issue:
Volume 9, Issue 4, July 2021
Pages:
160-165
Received:
30 May 2021
Accepted:
15 June 2021
Published:
23 June 2021
Abstract: This study intended to assess the effectiveness ten years later, after attending to a combined or aerobic exercise training program, in Chronic Obstructive Pulmonary Disease (COPD) patients. Methods: Twenty moderate COPD men, were randomized into two groups: ten patients (age-66.5±6.2 years) to a combined exercise training program (CETG), and ten (age-65.4±3.6 years) to an aerobic program (AETG), for 10W, 3xW. Outcome variables included cardiopulmonary function (cardiopulmonary exercise test (CPET) and 6-min-walk-distance (6MWD), muscular strength (1-RM); and quality of life (HRQL) with SF-36 and SGRQ. Ten years later, both groups were compared with ten patients who weren’t submitted to exercise programs (CG), evaluating health service recurrence (HSR) and respiratory mortality. Results: Both exercise groups increased (p<.05) functional capacity (VO2peak: CETG-25±18%, AETG-26±25%); CPET time/power (CETG-42±30%, AETG-65±47%), 6MWD (CETG, 12±3%; AETG, 7±4%) and HRQL immediately after exercise, with greater benefits for the CETG (p<.05) in all variables. Ten years later, there were no differences between exercise groups on mortality and HSR. Between exercise groups and CG there were only significant differences on HSR. Conclusions: Combined exercise was more effective than aerobic with greater improvement in muscular strength, functional capacity and HRQL. Participation in exercise programs seems to reduce HSR at long-term follow-up.
Abstract: This study intended to assess the effectiveness ten years later, after attending to a combined or aerobic exercise training program, in Chronic Obstructive Pulmonary Disease (COPD) patients. Methods: Twenty moderate COPD men, were randomized into two groups: ten patients (age-66.5±6.2 years) to a combined exercise training program (CETG), and ten (...
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Beyond “Normal”: Optimal Levels of Medical Parameters for Assessing Positive Health
Abhaya Indrayan,
Gayatri Vishwakarma,
Sanjeev Sarmukaddam,
Saumya Verma
Issue:
Volume 9, Issue 4, July 2021
Pages:
166-170
Received:
13 June 2021
Accepted:
26 June 2021
Published:
30 June 2021
Abstract: Background: Whereas the concept of normal levels of various parameters is extensively used in medical practice, the concept of optimal levels has not received much attention. We propose that it is time to pay attention to the optimal levels so that positive health can be measured. Objective: The objective is to define optimal levels of medical parameters as that combination which prevents the occurrence of ailments or gives strength to fight these ailments if they occur. Methods: A large number of articles and other literature was reviewed in search of medical parameters and their levels that could be considered to indicate optimal levels. Result: The optimal combination of medical parameters that prevents occurrence of ailments and gives strength to fight if an ailment occurs, is conceptually beyond the ‘normal’ levels that we use in everyday clinical practice and can be considered to indicate positive health. This is illustrated with the help of several examples after dividing the concept of positive health into five domains on the pattern of quality-of-life assessment. Conclusion: A concept of positive health has been proposed and its link to the optimal level of medical parameters is described. We plead that more efforts be made to identify the positive parameters of health, and their optimal levels that measure positive health be delineated.
Abstract: Background: Whereas the concept of normal levels of various parameters is extensively used in medical practice, the concept of optimal levels has not received much attention. We propose that it is time to pay attention to the optimal levels so that positive health can be measured. Objective: The objective is to define optimal levels of medical para...
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Efficacy and Tolerability of Oral Iron Protein Succinylate in the Treatment of Iron Deficiency Anemia in Adults with Diverse Pathologies
Issue:
Volume 9, Issue 4, July 2021
Pages:
171-185
Received:
16 May 2021
Accepted:
7 June 2021
Published:
9 July 2021
Abstract: An increasing number of prevalent conditions in the adult population associated with absolute or/and functional iron deficiencies (ID) may predispose to iron deficiency anemia (IDA). Oral iron formulations, especially ferrous salts, are generally regarded as the first line therapies for adult-onset ID and IDA according to several current guidelines. However, they have been frequently associated with gastrointestinal side effects, and with a subsequent high treatment discontinuation. Iron protein succinylate (IPS) is an iron complex containing 5% of ferric iron engulfed in a succinylated casein shell that precipitates in acid pH and becomes soluble at neutral to alkaline pH, gradually releasing iron into the intestinal lumen, and, hence, overcoming the gastric and intestinal problems of the ferrous compounds, as well as improving intestinal iron absorption. Besides, IPS has shown to prevent the up regulation of the expression of hepcidin or to induce its expression at a smaller extent when compared with ferrous sulphate (FS). This narrative review addresses the efficacy and safety profiles of IPS for the treatment of ID and IDA in adult patients with a wide range of clinical conditions, such as preoperative and postoperative ID, elderly ID, Chronic Kidney Disease (CKD), Hypothyroidism, regular blood donors, and ID developed in young athletes. In conclusion, IPS compares favorably in efficacy and safety with other currently available oral iron preparations, showing a fast and steady improvement in hematologic parameters (that reflect a better iron absorption), and a lower incidence of adverse events.
Abstract: An increasing number of prevalent conditions in the adult population associated with absolute or/and functional iron deficiencies (ID) may predispose to iron deficiency anemia (IDA). Oral iron formulations, especially ferrous salts, are generally regarded as the first line therapies for adult-onset ID and IDA according to several current guidelines...
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Carvedilol in Patients with Acutely Decompensated Systolic Heart Failure: Effects on Survival
Francisco Jose Sánchez Rivas,
Jose Hipolito Donis Hernández,
Carmen Mazzei De Dávila,
Maite Alexandra González,
Diego Fernando Dávila
Issue:
Volume 9, Issue 4, July 2021
Pages:
186-193
Received:
19 June 2021
Accepted:
5 July 2021
Published:
9 July 2021
Abstract: Ninety-eight patients with acutely decompensated systolic heart failure were admitted to the Hospital Universitario de Los Andes between 2005 and 2011, in Mérida, Venezuela. Medical Treatment: Protocol 1: Furosemide 20 mg IV every 8 hours (28 patients). Protocol 2: Furosemide 20 IV every 24 hours plus cautious uptitration of carvedilol (70 patients). Heart rate decreased from 99.19±12.38 to 67.64±11.27 (bpm) (p < 0.0001) with protocol 2. Daily weight changes were similar both protocols. Mean maximum dose of carvedilol was 59.37 mg, furosemide 240 mg for protocol 1 and 80 mg for protocol 2. For the whole group of patients, survival probability was close to 60% at fifty months of follow up. There were fourteen deaths with protocol 1 and eleven with protocol 2. Survival probability was significantly higher, in patients assigned to protocol 2 versus protocol 1 (72% vs 38%, p< 0.046). Cox multiple regression analysis indicated that, medical treatment with carvedilol, was significantly and independently associated to survival, only in those patients who were in sinus rhythm. Cautious uptitration of carvedilol, in still decompensated patients with sinus rhythm, increases long term survival.
Abstract: Ninety-eight patients with acutely decompensated systolic heart failure were admitted to the Hospital Universitario de Los Andes between 2005 and 2011, in Mérida, Venezuela. Medical Treatment: Protocol 1: Furosemide 20 mg IV every 8 hours (28 patients). Protocol 2: Furosemide 20 IV every 24 hours plus cautious uptitration of carvedilol (70 patients...
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Atypical Pancreatic Cystadenocarcinoma in Pregnant Women: A Case Report
Han Li,
Dongdong Ji,
Chenglong Guo,
Xuewen Wang,
Xingyuan Zhang,
Lingqun Kong
Issue:
Volume 9, Issue 4, July 2021
Pages:
194-197
Received:
6 July 2021
Accepted:
19 July 2021
Published:
29 July 2021
Abstract: Pancreatic cystic lesion (PCL) is a relatively low incidence of pancreatic disease. No clinical symptoms of PCL prevalence rate is 2.4% ~ 13.5% and has a tendency to increase with the increase of age. With the development of modern imaging technology and the improvement of people health consciousness, there has been a dramatic increase in the prevalence of PCL. PCLs involving a wide range of pathology can range from obviously benign to borderline malignant potential lesions to overt malignancy. Pancreatic cystadenocarcinoma belongs to one of the malignant tumor of PCLs, may be malignant from pancreatic cystadenoma, and it is clinically rare, accounting for only 1% of the malignant tumors of the pancreas. Preoperative diagnosis is difficult of the disease, it mostly need to postoperative pathological diagnosis. The main symptoms of pancreatic cystadenocarcinoma are dull pain or low back pain in the upper and middle abdomen, and mass in the upper abdomen. Abdominal pain is not intense, some patients only for the feeling of fullness discomfort. Other symptoms may include loss of appetite, nausea, indigestion, weight loss, jaundice, and in a few patients, gastrointestinal bleeding. In this paper, we report a rare case of pancreatic cystadenocarcinoma with a huge cystic lesion that grows rapidly in a short period of time in pregnant women, which preoperative diagnosis is considered pancreatic cystadenoma in the preoperative. Complete resection was performed and histological examination confirmed the diagnosis of pancreatic cystadenocarcinoma.
Abstract: Pancreatic cystic lesion (PCL) is a relatively low incidence of pancreatic disease. No clinical symptoms of PCL prevalence rate is 2.4% ~ 13.5% and has a tendency to increase with the increase of age. With the development of modern imaging technology and the improvement of people health consciousness, there has been a dramatic increase in the preva...
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Association Between Serum Magnesium Level and Metabolic Syndrome Prevalence in Chinese Adults: A Population Study
Mengyao Zhou,
Jing Wang,
Junhao Wang,
Wenjie Yang
Issue:
Volume 9, Issue 4, July 2021
Pages:
198-203
Received:
18 July 2021
Accepted:
28 July 2021
Published:
4 August 2021
Abstract: Aims: To assess the relationship between the level of serum magnesium and metabolic syndrome in Chinese adults. Methods: We used data from the China Health and Nutrition Survey (CHNS) conducted in 2009, and conducted investigated a cross-sectional study of 7364 Chinese subjects. A total of 1676 people (659 men and 1067 women) met the criteria of metabolic syndrome. Rank correlation analysis and binary Logistic regression analysis were performed to analyze the influence of serum magnesium concentrations, provinces and gender on the prevalence of metabolic syndrome. Results: The prevalence of metabolic syndrome is 22.8%. The concentration of serum magnesium in people with metabolic syndrome is higher than that in healthy groups (0.95 mmol/L vs 0.93 mmol/L, P<0. 001). The serum magnesium concentration and the prevalence of metabolic syndrome are higher in magnesium-rich areas than in non-magnesium-rich ones, with significant differences. (serum magnesium: t = 7.078, P<0. 001; metabolic syndrome: χ2=46.529, P<0. 001.) The Spearman rank correlation coefficient between serum magnesium level and the prevalence of metabolic syndrome is 0.903 in males, and 0.891 in females. All participants were divided into four groups according to the serum magnesium concentration quartile. The risk of metabolic syndrome increases by 1.595 times (95% CI 1.358-1.873). Conclusion: Higher serum magnesium concentration may be a risk factor for metabolic syndrome. Serum magnesium concentration is moderately and even highly correlated with the prevalence of metabolic syndrome, and there is a gender difference in this relation.
Abstract: Aims: To assess the relationship between the level of serum magnesium and metabolic syndrome in Chinese adults. Methods: We used data from the China Health and Nutrition Survey (CHNS) conducted in 2009, and conducted investigated a cross-sectional study of 7364 Chinese subjects. A total of 1676 people (659 men and 1067 women) met the criteria of me...
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Trends in Opioid Death Rates Following Implementation of Nevada’s Opioid Prescribing Laws
Taylor Cornwell-Hinrichs,
Cara Wyant,
Cheryl Vanier,
Weldon Havins,
Joseph Paul Hardy
Issue:
Volume 9, Issue 4, July 2021
Pages:
204-209
Received:
19 July 2021
Accepted:
29 July 2021
Published:
4 August 2021
Abstract: In response to a rising opioid overdose epidemic, Nevada passed legislative bills SB 459, AB 474, and AB 239 between 2015 and 2019 to reduce opioid prescriptions and, in turn, opioid-related deaths in Nevada. This paper analyzes trends in opioid prescription rates relative to legal and illegal opioid death rates from June 2015 to May 2020 in Clark and Washoe Counties. Data on opioid prescriptions was obtained from the Nevada Board of Pharmacy. Data on all opioid-related deaths was obtained from the Clark County Office of the Coroner/Medical Examiner and the Washoe County Regional Medical Examiner. Clark County and Washoe County showed similar trends (P=0.07), where AB 474 was associated with a 27.4% overall drop in prescription rates (from 68 per 1,000 people to 50 per 1,000), and it set up a trend of declining opioid prescribing rates that continued through May 2020. Prescription opioid death rates declined with prescription rates over time (P<0.01), but illicit opioid deaths rose slightly (heroin) or dramatically (fentanyl) during the same period, with a particularly notable increase during the COVID-19 Stay at Home order. In conclusion, the goal of Nevada’s three opioid prescription bills was to reduce the rate of Nevadans dying from opioid overdoses, yet more Nevadans are dying from opioids now than before the bills passed. We recommend three provisions to help balance appropriate accessibility to pain management for patients with the need to limit prescription opioid deaths: (1) Base law requirements on guidelines provided by professional or governmental agencies that are medically oriented, (2) Discipline first with education, then with sanctions, and (3) Enforce requirements through an entity which is very familiar with the providers’ scope of practice, such as the Nevada State Board of Medical Examiners.
Abstract: In response to a rising opioid overdose epidemic, Nevada passed legislative bills SB 459, AB 474, and AB 239 between 2015 and 2019 to reduce opioid prescriptions and, in turn, opioid-related deaths in Nevada. This paper analyzes trends in opioid prescription rates relative to legal and illegal opioid death rates from June 2015 to May 2020 in Clark ...
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Incomplete Behcets’ Disease in a Teenager
Saraid Cerda-Reyes,
Irma Nancy Fernández-Morales,
Edgar Oswaldo Franco-Ramírez,
Abelardo Rodríguez-Reyes,
Adriana Alcántara-Salinas,
Vania Trejo-Uribe
Issue:
Volume 9, Issue 4, July 2021
Pages:
210-213
Received:
25 June 2021
Accepted:
22 July 2021
Published:
6 August 2021
Abstract: Background: Behçets’ disease (BD) is a multisystemic vasculitis with various manifestations: mucocutaneous, articular, ocular, gastrointestinal, musculoskeletal, neurological, cardiac and pulmonary, the most common of which is the presence of painful ulcers lasting more than 14 days that occurs at east 3 times in a year, either alone or in combination with other lesions. Association with HLA-B51 has been described and sometimes have a positive pathergy test. Histopathologic evaluation reveals a neutrophilic vascular reaction or leukocytoclastic vasculitis. Clinical case: We report the case of a 14-year-old teenager with a past medical history of allergic rhinitis diagnosed, but with a 3-year history of painful oral ulcers that present more than 3 times per year; he presented oral ulcers, he did not present at the ocular and genital level. The biopsy samples of oral lesions did consistent with BD (showed narrowing of the vascular lumen due to neutrophil and lymphocyte infiltrate that completely affects the vascular wall) and HLA B 51 positive. Immunosuppressive treatment was started with mycophenolate 400 mg/ BSA for one year and 50 mg of prednisone OD followed by a gradual taper with good response to therapeutic approach and decrease of oral ulcers until they disappear. We present the case of a patient with an incomplete type of BD, with recurrent aphthous ulcers that present more than 3 times during a 12-month period as well as Indian descent, a biopsy with neutrophilic vascular reaction and positive HLA B51. BD is more likely to develop in children aged 11.7 to 14.5 years with diagnosis based on the presence of oral ulcers in 87 to 98% of the cases. Genital ulcers are far less common in children that in adults; BD is also more frequent among males. BD prognosis is dominated by ocular, neurological and vascular damage, with a poor functional and/or vital prognosis. Ocular involvement is severe and frequent, rapidly involving the visual prognosis. Treatment must be individualized according to the organ involved, good response has been described with intravenous steroids, which represent the mainstay of treatment, immunosuppressive the most commonly. Conclusions: Recurrent oral ulcers with more than three occurrences in one year must be considered as a sign to rule out BD. We must carry out an interrogation and when suspected, it must be confirmed with histopathological study and HLA B 51, regardless of the age of the patient. The diagnosis of BD is a challenge for the clinician.
Abstract: Background: Behçets’ disease (BD) is a multisystemic vasculitis with various manifestations: mucocutaneous, articular, ocular, gastrointestinal, musculoskeletal, neurological, cardiac and pulmonary, the most common of which is the presence of painful ulcers lasting more than 14 days that occurs at east 3 times in a year, either alone or in combinat...
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Central Retinal Arterial and Venous Occlusion in a Patient with Systemic Sclerosis and a Review of the Related Literature
Aya Mori,
Kimimasa Nakabayashi,
Hiroko Konishi,
Ippei Doi,
Rie Tagaya,
Aya Nakase,
Masayoshi Iwakami
Issue:
Volume 9, Issue 4, July 2021
Pages:
214-218
Received:
14 July 2021
Accepted:
5 August 2021
Published:
27 August 2021
Abstract: Systemic sclerosis (SSc) is known to cause serious complications at an advanced stage. However, serious ocular complications such as central retinal artery occlusion (CRAO) and/or central retinal vein occlusion (CRVO) have only been reported in a few cases to date. A 51-year-old man with severe Raynaud’s phenomenon, scleroderma up to the forearm and a negative anti-nuclear antibody (ANA) finding developed pulmonary fibrosis (PF) and was admitted to the hospital for the treatment of dyspnea under the diagnosis of SSc. A transbronchial lung biopsy performed 10 days after admission demonstrated mucoid intimal thickening (MIT) of the small arteries in the peripheral lung tissue and the bronchial wall. Prednisolone (PSL), ciclosporin and nintedanib were prescribed for PF treatment but failed to induce any apparent improvement in dyspnea. Finally, methylprednisolone pulse therapy (1.0 g, 3 times) and intravenous cyclophosphamide (IVCY, 500 mg, 6 times) therapy were instituted with a subsequent decrease in the patient’s Krebs von den Lungen 6 (KL-6) and surfactant protein D (SP-D) levels. During IVCY therapy, the patient experienced blurred vision in the right eye, and this was diagnosed as being due to CRAO and CRVO. However, the patient did not manifest any embolic, coagulopathic, or vasculitic symptoms, and there were no abnormal laboratory data suggesting these diseases in relation to this symptom. Therefore, the ocular occlusion was presumed to be due to MIT of small arteries, in addition to severe Raynaud’s phenomenon. Thus, we report the findings of this important case, despite the fact that it lacks a retinal pathology.
Abstract: Systemic sclerosis (SSc) is known to cause serious complications at an advanced stage. However, serious ocular complications such as central retinal artery occlusion (CRAO) and/or central retinal vein occlusion (CRVO) have only been reported in a few cases to date. A 51-year-old man with severe Raynaud’s phenomenon, scleroderma up to the forearm an...
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