Wybrane aspekty epidemiologiczne stwardnienia rozsianego w Polsce – wieloośrodkowe badanie pilotażowe

Background and purpose The aim was to conduct a pilot study of selected epidemiological aspects of multiple sclerosis (MS) in Poland. Material and methods Cross-sectional data were collected in 21 centres providing MS treatment. The demographic profile of the patients, medical history of MS, disability status, comorbidity, and diagnostic and treatment modalities were analysed. Results Data on 3581 patients were obtained, including 2494 women (69.6%) and 1030 men (28.8%) – sex ratio 2.4 : 1. The mean age was 40.7 ± 11.9 years. Monofocal onset was reported in 80.8% of cases – the most frequently reported location of lesions was supratentorial (36.1%), followed by optic nerves (26.5%) and spinal cord (20.1%). The mean disease duration was 10.2 ± 8.8 years (range 0.04–53 years), and the mean time from the first symptoms to MS diagnosis was 2.6 years. Relapsing-remitting MS was reported in 70.5% of patients, secondary progressive in 16.8%, primary progressive in 8.4%, and ‘benign MS’ in 2.5%. The mean EDSS score was 3.3 ± 2.2 (range 0–9.5). The family history of MS was positive in 6.4% of cases. Comorbidity mainly applied to the musculoskeletal system (6.5%), the urinary system (5.8%) and psychiatric disturbances (5.5%). Brain magnetic resonance studies were available in 96.3% of the patients, evoked potentials in 54%, and cerebrospinal fluid testing in 63.1% – of whom only 41.2% were tested for oligoclonal bands, with 84% of samples being positive. Immunomodulatory drugs were used in 842 patients (24%), predominandy interferon beta (81%) and glatiramer (13%). Mitoxantrone was the most commonly used immunosuppressant. Conclusions This project is the first countrywide large-scale MS survey, covering approximately 18% of patients, according to our estimates. The results identify the clinical condition of the patients, as well as diagnostic and treatment modalities.Wstęp i cel pracy Celem badania była pilotażowa analiza wybranych aspektów epidemiologicznych stwardnienia rozsianego (SR) w Polsce. Materiał i metody Przekrojowe dane zebrano w 21 ośrodkach prowadzących leczenie SR. Analizowano profil demograficzny chorych, wywiad chorobowy SR, stopień niepełnosprawności, choroby współwystępujące, metody diagnostyczne i stosowane leczenie. Wyniki Uzyskano dane 3581 pacjentów, w tym 2494 kobiet (69,6%) i 1030 mężczyzn (28,8%) – proporcja płci 2,4 : 1. Średni wiek wynosił 40,7 ± 11,9 roku. Początek jednoogniskowy odnotowano w 80,8% przypadków – najczęściej wskazywano na nadnamiotową lokalizację uszkodzeń (36,1%), w dalszej kolejności zajęte były nerwy wzrokowe (26,5%) i rdzeń kręgowy (20,1%). Choroba trwała średnio 10,2 ± 8,8 roku (zakres 0,04–53 lat), a od pierwszych objawów do ustalenia rozpoznania mijało średnio 2,6 roku. Postać nawra-cająco-zwalniającą SR miało 70,5% chorych, wtórnie postępującą – 16,8%, pierwotnie postępującą – 8,4%, u 2,5% rozpoznano zaś „łagodne” SR. Średni stopień niesprawności w skali EDSS wyniósł 3,3 ±2,2 (zakres 0–9,5). Rodzinne występowanie SR odnotowano w 6,4% przypadków. Wśród chorób współwystępujących najczęstsze były schorzenia narządu ruchu (6,5%), układu moczowego (5,8%) i zaburzenia psychiczne (5,5%). Rezonans magnetyczny mózgu wykonano u 96,3% pacjentów, potencjały wywołane u 54%, badanie płynu mózgowo-rdzeniowego u 63,1% – z czego zaledwie w 41,2% przypadków oznaczano prążki oligoklonalne (ich obecność stwierdzono w 84% próbek). Leki immunomodulujące otrzymywało 842 chorych (24%), najczęściej były to interferon β (81%) i glatiramer (13%). W immunosupresji najczęściej stosowano mitoksantron. Wnioski Zrealizowany projekt jest pierwszym ogólnopolskim badaniem populacji chorych na SR na tak szeroką skalę – wg naszych szacunków obejmującym ok. 18% populacji chorych. Zgromadzone wyniki informują o stanie klinicznym chorych, najczęstszych metodach diagnostyki i leczenia

Implementation of less invasive surfactant administration in clinical practice-Experience of a mid-sized country.

OBJECTIVE:There are differences in the adoption rates of less invasive surfactant administration (LISA) worldwide. We aimed to describe and analyze the process of LISA introduction at the country level. METHODS:A standardized training program (33 courses covering >500 neonatologists) was followed by a cohort study. Data regarding consecutive LISA procedures were acquired over 12 months in 31 tertiary neonatal centers, using a dedicated on-line platform. RESULTS:Of 500 LISA procedures, 75% were performed by specialists and 25% by residents. The mean percentage share of LISA in all surfactant therapies was 24%, which represents a 6-fold increase compared to previous years. After 12 months, 76% of the procedures were rated "easy/very easy" vs 59% at baseline (p<0.05). Surfactant re-treatment rate was 15%. Twenty-three percent of infants required mechanical ventilation within 72 hours of life. Oxygen desaturation and surfactant reflux were the most frequent complications. Unlike previous reports describing exclusive use of nasal continuous positive airway pressure (nCPAP) during LISA, majority of procedures (63%) were carried out using nasal intermittent positive pressure ventilation (NIPPV) or Bilevel Positive Airway Pressure (BiPAP). Efficacy of LISA with NIPPV or BiPAP was not significantly different from that with nCPAP (22.4% vs 24.5% of cases requiring intubation). Ventilation was provided with nasal cannulas or nasal masks (90%) and rarely with "RAM" cannulas or nasopharyngeal tubes. Rigid catheters were preferred (88.4%); tracheal insertion was successful at first attempt in 87% of cases. Majority of infants (79%) received no premedication prior to the procedure and almost all were given caffeine citrate. Median time of instillation was 1.5 minutes. CONCLUSIONS:The LISA procedure does not appear to be technically difficult to master. Training combining theory with practical exercises is an efficient implementation strategy. Variations in adoption rates indicate the need for additional, more personalized teachings in some centers

Égypte... : guide... / rédigé par M. Georges Bénédite,...

Collection : Collection des guides JoanneCollection : Collection des guides JoanneNumérisé par le partenaireNumérisé par le partenair

Patient flow diagram.

<p>DOL = Day of Life.</p

Study endpoints in PS-matched infants.

<p>Study endpoints in PS-matched infants.</p

Comparison of the effects of “early” and “late” caffeine therapy on the risk of typical complications of prematurity.

<p>Comparison of the effects of “early” and “late” caffeine therapy on the risk of typical complications of prematurity.</p

Comparison of the effects of “early” and “late” caffeine therapy on the risk of typical complications of prematurity.

<p>Comparison of the effects of “early” and “late” caffeine therapy on the risk of typical complications of prematurity.</p

Clinical characteristics of the study cohort (N = 844) overall and within groups paired using the PSM method (N = 286).

<p>Clinical characteristics of the study cohort (N = 844) overall and within groups paired using the PSM method (N = 286).</p