Showing papers by "British Hospital published in 2013"

Clinical practice guidelines for the management of hypothyroidism

Abstract: INTRODUCTION: Hypothyroidism has long been known for its effects on different organ systems, leading to hypometabolism. However, subclinical hypothyroidism, its most prevalent form, has been recently related to cardiovascular risk and also to maternal-fetal complications in pregnant women. OBJECTIVES: In these clinical practice guidelines, several aspects of this field have been discussed with the clear objectives of helping physicians treat patients with hypothyroidism, and of sharing some of our Latin American-based clinical experience. MATERIALS AND METHODS: The Latin American Thyroid Society commissioned a Task Force on Hypothyroidism to develop evidence-based clinical guidelines on hypothyroidism. A systematic review of the available literature, focused on the primary databases of MedLine/PubMed and Lilacs/SciELO was performed. Filters to assess methodological quality were applied to select the best quality studies. The strength of recommendation on a scale from A-D was based on the Oxford Centre for Evidence--based Medicine, Levels of Evidence 2009, allowing an unbiased opinion devoid of subjective viewpoints. The areas of interest for the studies comprised diagnosis, screening, treatment and a special section for hypothyroidism in pregnancy. RESULTS: Several questions based on diagnosis, screening, treatment of hypothyroidism in adult population and specifically in pregnant women were posed. Twenty six recommendations were created based on the answers to these questions. Despite the fact that evidence in some areas of hypothyroidism, such as therapy, is lacking, out of 279 references, 73% were Grade A and B, 8% Grade C and 19% Grade D. CONCLUSIONS: These evidence-based clinical guidelines on hypothyroidism will provide unified criteria for management of hypothyroidism throughout Latin America. Although most of the studies referred to are from all over the world, the point of view of thyroidologists from Latin America is also given.

Daily baseline skin care in the prevention, treatment, and supportive care of skin toxicity in oncology patients: recommendations from a multinational expert panel.

Abstract: Skin reactions due to radiotherapy and chemotherapy are a significant problem for an important number of cancer patients. While effective for treating cancer, they disturb cutaneous barrier function, causing a reaction soon after initiation of treatment that impacts patient quality of life. Managing these symptoms with cosmetics and nonpharmaceutical skin care products for camouflage or personal hygiene may be important for increasing patient self-esteem. However, inappropriate product choice or use could worsen side effects. Although recommendations exist for the pharmaceutical treatment of skin reactions, there are no recommendations for the choice or use of dermatologic skin care products for oncology patients. The present guidelines were developed by a board of European experts in dermatology and oncology to provide cancer care professionals with guidance for the appropriate use of non-pharmaceutical, dermocosmetic skin care management of cutaneous toxicities associated with radiotherapy and systemic chemotherapy, including epidermal growth factor inhibitors and monoclonal antibodies. The experts hope that these recommendations will improve the management of cutaneous side effects and hence quality of life for oncology patients.

Two-dimensional speckle tracking echocardiography for early detection of myocardial damage in young patients with Fabry disease.

Abstract: Fabry disease (FD) is characterized by left ventricular hypertrophy (LVH). Conventional echocardiography is not sensitive enough to perform the preclinical diagnosis To assess whether longitudinal myocardial strain of the left ventricle (LV), using speckle tracking, is useful to detect early myocardial involvement in FD. Forty-four patients with FD who were diagnosed with genetic testing were prospectively included and were compared to a sex-matched control group. They were divided into three groups: 22 with LVH (Group I), 22 without LVH (Group II), and 22 healthy volunteers (Group III). LV longitudinal strain was measured from the apical views. An ANOVA test was used for multiple comparisons for variables with a normal distribution, and a Kruskal-Wallis test was used for variables with non-Gaussian distribution. Longitudinal LV strain was different in the three groups: it was ≥-15% in at least one segment in all Group I patients, in 50% of patients of Group II and in no patient of Group III. Seventy percent of the segments with abnormal strain in Group II were located in the basal regions (32/46). These findings show that the presence of at least one strain value ≥-15% demonstrates subclinical myocardial dysfunction in patients with preclinical FD. Longitudinal myocardial LV strain measured with speckle tracking is a useful tool to detect early myocardial involvement in young patients with FD. This information allows the detection and treatment of myocardial dysfunction at an early stage, which is of high clinical importance.

Systematic review and network meta-analysis of interventions for fibromyalgia: a protocol

Abstract: Background: Fibromyalgia is associated with substantial socioeconomic loss and, despite considerable research including numerous randomized controlled trials (RCTs) and systematic reviews, there exists uncertainty regarding what treatments are effective. No review has evaluated all interventional studies for fibromyalgia, which limits attempts to make inferences regarding the relative effectiveness of treatments. Methods/design: We will conduct a network meta-analysis of all RCTs evaluating therapies for fibromyalgia to determine which therapies show evidence of effectiveness, and the relative effectiveness of these treatments. We will acquire eligible studies through a systematic search of CINAHL, EMBASE, MEDLINE, AMED, HealthSTAR, PsychINFO, PapersFirst, ProceedingsFirst, and the Cochrane Central Registry of Controlled Trials. Eligible studies will randomly allocate patients presenting with fibromyalgia or a related condition to an intervention or a control. Teams of reviewers will, independently and in duplicate, screen titles and abstracts and complete full text reviews to determine eligibility, and subsequently perform data abstraction and assess risk of bias of eligible trials. We will conduct meta-analyses to establish the effect of all reported therapies on patient-important outcomes when possible. To assess relative effects of treatments, we will construct a random effects model within the Bayesian framework using Markov chain Monte Carlo methods. Discussion: Our review will be the first to evaluate all treatments for fibromyalgia, provide relative effectiveness of treatments, and prioritize patient-important outcomes with a focus on functional gains. Our review will facilitate evidence-based management of patients with fibromyalgia, identify key areas for future research, and provide a framework for conducting large systematic reviews involving indirect comparisons.

Algorithm for dermocosmetic use in the management of cutaneous side-effects associated with targeted therapy in oncology

Abstract: Currently, numerous patients who receive targeted chemotherapy for cancer suffer from disabling skin reactions due to cutaneous toxicity, which is a significant problem for an increasing number of patients and their treating physicians. In addition, using inappropriate personal hygiene products often worsens these otherwise manageable side-effects. Cosmetic products for personal hygiene and lesion camouflage are part of a patients’ well-being and an increasing number of physicians feel that they do not have adequate information to provide effective advice on concomitant cosmetic therapy. Although ample information is available in the literature on pharmaceutical treatment for cutaneous side-effects of chemotherapy, little is available for the concomitant use of dermatological skin-care products with medical treatments. The objective of this consensus study is to provide an algorithm for the appropriate use of dermatological cosmetics in the management of cutaneous toxicities associated with targeted chemotherapy such as epidermal growth factor receptor inhibitors and other monoclonal antibodies. These guidelines were developed by a French and German expert group of dermatologists and an oncologist for oncologists and primary care physicians who manage oncology patients. The information in this report is based on published data and the expert group’s opinion. Due to the current lack of clinical evidence, only a review of published recommendations including suggestions for concomitant cosmetic use was conducted.

Postural response characterization in elderly patients with bilateral vestibular hypofunction

Abstract: Conclusions: The measurement of the energy consumption (EC) of the body's center of pressure (COP) to maintain the upright stance position was higher in elderly patients with bilateral vestibular hypofunction (BVH) compared with a control group and may be a valid parameter in the assessment of balance disorders. Objective: The aim of the study was to evaluate the energy consumption of the COP in elderly patients with BVH. Methods: The COP was recorded on a force platform (FP) for eight elderly patients with BVH related to aging and eight normal control group subjects. The EC of the COP was calculated using the discrete wavelet transform. The two groups were tested in standing position on the FP in three sensory conditions:1, eyes open; 2, eyes closed; and 3, standing on a foam pad placed on the force platform. Wilcoxon's rank test and multi-factor analysis of variance were used, with the level of significance set at 0.05. Results: BVH patients showed higher values of EC of the COP signal measured...

The scapholunate ligament complex.

Abstract: Although the full pathogenesis of the Scapholunate Ligament-Complex (SLLC) is not yet completely understood and remains a challenging subject, one must consider that a great deal of progress has been made in the recent past, on the comprehension of the different stages of its lesion, and by consequence, on the treatment options available. It also an unavoidable truth, that wrist arthroscopy brought about a clear and sound knowledge of the precise dimension and pattern of the intercarpal lesions, contributing to improved and more accurate classification systems that permit a better definition between attenuation versus instability and the appropriate proposed treatment for its resolution. The excellent articles included in this issue of the Journal of Wrist Surgery, show us that the move is on its way, and the all inside arthroscopic procedures for dorsal/volar or combined SLIL repairs are very promising techniques for the early stages, taking into account the short term results of these procedures. In my view, and if one takes into consideration the importance of wrist proprioception, based on the brilliant work of Elisabeth Hager (Karolinska Institute) and Richard Berger (Mayo Clinic), on the importance of the mechanoreceptors on carpus reflexes, one must believe that arthroscopic procedures may be have a great, beneficial contribution on the preservation of the integrity of these receptors and on the final, expected result. To put it another way, open reconstructive techniques are of great value for more advanced lesions affecting all SLLC, knowing that the carpus disorganization has progressed in such way that a multiple ligament approach for carpus anatomy repositioning and function, is imperative. In this respect, and due to the magnitude of these reconstructive procedures, residual limitations are expected as far as range of wrist movement is concerned, although a good subjective result is generally obtained. In closing, and knowing that in principle we are in the presence of a progressive lesion, I would like to emphasize the importance of an early diagnosis of an SL lesion. The wrist societies should address the first line on the attendance of wrist injuries, namely traumatology centers, general orthopedic and plastic surgeons, that a minor wrist sprain or a wrist ganglion might be the initial sign of a SL lesion, and a referral to a wrist center, at the appropriate time, might make the all difference between an all inside arthroscopic procedure for an attenuation lesion and an open reconstructive, or even salvage procedure, for an irreversible SLAC wrist. This is a combined work, which we must make together.

P1.013 Emergence of Neisseria Gonorrhoeae Isolates with in Vitro Decreased Susceptibility to Ceftriaxone in Argentina

Abstract: Background N. gonorrhoeae (Ng) has developed resistance to most antimicrobial used for treatment. The report of the first resistant isolates of Ceftriaxone (CRO) in Japan, France and Spain, highlighted the lack of alternatives for syndromic treatment of Ng. In Argentina, although no resistance has been reported, the first isolates with decreased susceptibility to CRO (CROLS) appear in 2011. Materials and Methods: We studied 5649 Ng isolates since 1993 derived from Argentine Gonococcal Antimicrobial-Susceptibility Network. MIC was determined by agar dilution according to CLSI recommendations. We studied extended spectrum cephalosporins (ESCs) resistance determinant ( mtr , pen A, por B) by sequencing and carry out the molecular typing by Ng multi-antigen sequence typing (NG-MAST). Results We detected 10 CROLS isolates, 4 showed a CRO MICs of 0.064 μg/ml and 6 of them of 0.125 μg/ml. All isolates were also resistant to two or more antimicrobial agents (Penicilin and Tetracycline and/or Ciprofloxacin) and showed decreased susceptibility to Cefixime with MICs between 0.125 and 0.5 µg/ml. Six NG-MAST sequence types (STs) were detected, with ST925 (n = 3) and ST1407 (n = 3) being most common. Also found ST225, ST3620 and two new STs: ST8508 and ST8509. The pen A gene analysis revealed three different no mosaic alleles patterns: V (n = 1), IX (n = 1) and XII (n = 1) and two mosaic alleles patterns: XXXIV (n = 4) and X (n = 3). Nine isolates showed mutations in G120 and A121 positions in por B1b allele and one isolate revealed A121G substitution in allele por B1a, both previously described. All isolates carried a nucleotide (A) deletion in the inverted region of mtr R gene. Conclusion The evidence of the first isolates with decreased susceptibility to ESC in Argentina and the presence of ST1407 involved in the extensively drug resistant Ng raise the need for emphasise surveillance studies to ESC and know the distribution of ST1407 in our Region and its associated resistance.