226 research outputs found
Evidenceâbased treatment for gynoid lipodystrophy: A review of the recent literature
Resumen La lipodistrofia ginoide (LDG) es una alteracion estructural, inflamatoria y bioquımica del tejido subcutaneo que causa modificaciones topograficas en la piel. Conocida comunmente como âcelulitisâ, la LDG afecta hasta a 90% de las mujeres, practicamente en todas las etapas de la vida, iniciando en la pubertad. Se trata de una condicion que afecta considerablemente la calidad de vida de quien la padece. Es motivo frecuente de consulta aunque las pacientes recurren a tratamientos empıricos, improvisados, sin bases ni evidencia cientıfica, los cuales desmotivan y producen frustracion no solo por su falta de resultados, sino por complicaciones derivadas de dichos tratamientos. Un grupo de expertos de diversas especialidades involucradas en el manejo de este problema presenta en este artıculo el resultado de una busqueda bibliografica sistematica y de la discusion consensuada de la evidencia obtenida de diversos tratamientos disponibles actualmente. El analisis se dividio en tratamientos topicos, tratamientos sistemicos, tratamientos no invasivos y tratamientos mınimamente invasivos
Randomized Trial of Anticoagulation Strategies for Noncritically Ill Patients Hospitalized With COVID-19.
BACKGROUND
Prior studies of therapeutic-dose anticoagulation in patients with COVID-19 have reported conflicting results.
OBJECTIVES
We sought to determine the safety and effectiveness of therapeutic-dose anticoagulation in noncritically ill patients with COVID-19.
METHODS
Patients hospitalized with COVID-19 not requiring intensive care unit treatment were randomized to prophylactic-dose enoxaparin, therapeutic-dose enoxaparin, or therapeutic-dose apixaban. The primary outcome was the 30-day composite of all-cause mortality, requirement for intensive care unit-level of care, systemic thromboembolism, or ischemic stroke assessed in the combined therapeutic-dose groups compared with the prophylactic-dose group.
RESULTS
Between August 26, 2020, and September 19, 2022, 3,398 noncritically ill patients hospitalized with COVID-19 were randomized to prophylactic-dose enoxaparin (n = 1,141), therapeutic-dose enoxaparin (n = 1,136), or therapeutic-dose apixaban (n = 1,121) at 76 centers in 10 countries. The 30-day primary outcome occurred in 13.2% of patients in the prophylactic-dose group and 11.3% of patients in the combined therapeutic-dose groups (HR: 0.85; 95% CI: 0.69-1.04; P = 0.11). All-cause mortality occurred in 7.0% of patients treated with prophylactic-dose enoxaparin and 4.9% of patients treated with therapeutic-dose anticoagulation (HR: 0.70; 95% CI: 0.52-0.93; P = 0.01), and intubation was required in 8.4% vs 6.4% of patients, respectively (HR: 0.75; 95% CI: 0.58-0.98; P = 0.03). Results were similar in the 2 therapeutic-dose groups, and major bleeding in all 3 groups was infrequent.
CONCLUSIONS
Among noncritically ill patients hospitalized with COVID-19, the 30-day primary composite outcome was not significantly reduced with therapeutic-dose anticoagulation compared with prophylactic-dose anticoagulation. However, fewer patients who were treated with therapeutic-dose anticoagulation required intubation and fewer died (FREEDOM COVID [FREEDOM COVID Anticoagulation Strategy]; NCT04512079).Dr Stone has received speaker honoraria from Medtronic, Pulnovo,
Infraredx, Abiomed, and Abbott; has served as a consultant to
Daiichi-Sankyo, Valfix, TherOx, Robocath, HeartFlow, Ablative Solutions, Vectorious, Miracor, Neovasc, Ancora, Elucid Bio, Occlutech,
CorFlow, Apollo Therapeutics, Impulse Dynamics, Cardiomech, Gore,
Amgen, Adona Medical, and Millennia Biopharma; and has equity/
options from Ancora, Cagent, Applied Therapeutics, Biostar family of
funds, SpectraWave, Orchestra Biomed, Aria, Cardiac Success, Valfix,
and Xenter; his daughter is an employee at IQVIA; and his employer,
Mount Sinai Hospital, receives research support from Abbott,
Abiomed, Bioventrix, Cardiovascular Systems Inc, Phillips, BiosenseWebster, Shockwave, Vascular Dynamics, Pulnovo, and V-wave. Dr
Farkouh has received institutional research grants from Amgen,
AstraZeneca, Novo Nordisk, and Novartis; has received consulting
fees from Otitopic; and has received honoraria from Novo Nordisk. Dr
Lala has received consulting fees from Merck and Bioventrix; has
received honoraria from Zoll Medical and Novartis; has served on an
advisory board for Sequana Medical; and is the Deputy Editor for the
Journal of Cardiac Failure. Dr Moreno has received honoraria from
Amgen, Cuquerela Medical, and Gafney; has received payment for
expert testimony from Koskoff, Koskoff & Dominus, Dallas W. Hartman, and Riscassi & Davis PC; and has stock options in Provisio. Dr
Goodman has received institutional research grants from Bristol
Myers Squibb/Pfizer Alliance, Bayer, and Boehringer Ingelheim; has
received consulting fees from Amgen, Anthos Therapeutics, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CSL
Behring, Ferring Pharmaceuticals, HLS Therapeutics, Novartis, Pendopharm/Pharmascience, Pfizer, Regeneron, and Sanofi; has received
honoraria from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim,
Bristol Myers Squibb, Eli Lilly, Ferring Pharmaceuticals, HLS Therapeutics, JAMP Pharma, Merck, Novartis, Pendopharm/Pharmascience, Pfizer, Regeneron, Sanofi, and Servier; has served on Data
Safety and Monitoring boards for Daiichi-Sankyo/American Regent
and Novo Nordisk A/C; has served on advisory boards for Amgen,
AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, CSL
Behring, Eli Lilly, Ferring Pharmaceuticals, HLS Therapeutics, JAMP
Pharma, Merck, Novartis, Pendopharm/Pharmascience, Pfizer,
Regeneron, Sanofi, Servier, and Tolmar Pharmaceuticals; has a leadership role in the Novartis Council for Heart Health (unpaid); and
otherwise has received salary support or honoraria from the Heart
and Stroke Foundation of Ontario/University of Toronto (Polo) Chair,
Canadian Heart Failure Society, Canadian Heart Research Centre and
MD Primer, Canadian VIGOUR Centre, Cleveland Clinic Coordinating
Centre for Clinical Research, Duke Clinical Research Institute, New
York University Clinical Coordinating Centre, PERFUSE Research
Institute, and the TIMI Study Group (Brigham Health). Dr Ricalde has
received consulting fees from Medtronic, Servier, and Boston Scientific; has received honoraria from Medtronic, Pfizer, Merck, Boston
Scientific, Biosensors, and Bayer; has served on an advisory board for
Medtronic; and has leadership roles in SOLACI and Kardiologen. Dr
Payro has received consulting fees from Bayer Mexico; has received
honoraria from Bayer, Merck, AstraZeneca, Medtronic, and Viatris;
has received payments for expert testimony from Bayer; has received
travel support from AstraZeneca; has served on an advisory board for
Bayer; and his institution has received equipment donated from
AstraZeneca. Dr Castellano has received consulting fees and honoraria from Ferrer International, Servier, and Daiichi-Sankyo; and has
received travel support from Ferrer International. Dr Hung has served
as an advisory board member for Pfizer, Merck, AstraZeneca, Fosun,
and Gilead. Dr Nadkarni has received consulting fees from Renalytix,
Variant Bio, Qiming Capital, Menarini Health, Daiichi-Sankyo, BioVie,
and Cambridge Health; has received honoraria from Daiichi-Sankyo
and Menarini Health; has patents for automatic disease diagnoses
using longitudinal medical record data, methods, and apparatus for
diagnosis of progressive kidney function decline using a machine
learning model, electronic phenotyping technique for diagnosing
chronic kidney disease, deep learning to identify biventricular
structure and function, fusion models for identification of pulmonary
embolism, and SparTeN: a novel spatio-temporal deep learning
model; has served on a Data Safety and Monitoring Board for CRIC
OSMB; has leadership roles for Renalytix scientific advisory board,
Pensive Health scientific advisory board, and ASN Augmented Intelligence and Digital Health Committee; has ownership interests in
Renalytix, Data2Wisdom LLC, Verici Dx, Nexus I Connect, and Pensieve Health; and his institution receives royalties from Renalytix. Dr
Goday has received the Frederick Banting and Charles Best Canada
Graduate Scholarship (Doctoral Research Award) from the Canadian
Institutes of Health Research. Dr Furtado has received institutional
research grants from AstraZeneca, CytoDin, Pfizer, Servier, Amgen,
Alliar Diagnostics, and the Brazilian Ministry of Health; has received
consulting fees from Biomm and Bayer; has received honoraria from
AstraZeneca, Bayer, Servier, and Pfizer; and has received travel support from Servier, AstraZeneca, and Bayer. Dr Granada has received
consulting fees, travel support, and stock from Cogent Technologies
Corp; and has received stock from Kutai. Dr Contreras has served as a
consultant for Merck, CVRx, Novodisk, and Boehringer Ingelheim;
and has received educational grants from Alnylam Pharmaceuticals
and AstraZeneca. Dr Bhatt has received research funding from Abbott,
Acesion Pharma, Afimmune, Aker Biomarine, Amarin, Amgen,
AstraZeneca, Bayer, Beren, Boehringer Ingelheim, Boston Scientific,
Bristol Myers Squibb, Cardax, CellProthera, Cereno Scientific, Chiesi,
Cincor, CSL Behring, Eisai, Ethicon, Faraday Pharmaceuticals, Ferring
Pharmaceuticals, Forest Laboratories, Fractyl, Garmin, HLS Therapeutics, Idorsia, Ironwood, Ischemix, Janssen, Javelin, Lexicon, Lilly,
Medtronic, Merck, Moderna, MyoKardia, NirvaMed, Novartis, Novo
Nordisk, Owkin, Pfizer Inc, PhaseBio, PLx Pharma, Recardio, Regeneron, Reid Hoffman Foundation, Roche, Sanofi, Stasys, Synaptic, The
Medicines Company, Youngene, and 89bio; has received royalties
from Elsevier; has received consultant fees from Broadview Ventures
and McKinsey; has received honoraria from the American College of
Cardiology, Baim Institute for Clinical Research, Belvoir Publications,
Boston Scientific, Cleveland Clinic, Duke Clinical Research Institute,
Mayo Clinic, Mount Sinai School of Medicine, Novartis, Population
Health Research Institute, Rutgers University, Canadian Medical and
Surgical Knowledge Translation Research Group, Cowen and Company, HMP Global, Journal of the American College of Cardiology, K2P,
Level Ex, Medtelligence/ReachMD, MJH Life Sciences, Oakstone CME,
Piper Sandler, Population Health Research Institute, Slack Publications, WebMD, Wiley, Society of Cardiovascular Patient Care; has
received fees from expert testimony from the Arnold and Porter law
firm; has received travel support from the American College of Cardiology, Society of Cardiovascular Patient Care, American Heart Association; has a patent for otagliflozin assigned to Brigham and
Womenâs Hospital who assigned to Lexicon; has participated on a
data safety monitoring board or advisory board for Acesion Pharma,
Assistance Publique-HĂŽpitaux de Paris, AngioWave, Baim Institute,
Bayer, Boehringer Ingelheim, Boston Scientific, Cardax, CellProthera,
Cereno Scientific, Cleveland Clinic, Contego Medical, Duke Clinical
Research Institute, Elsevier Practice Update Cardiology, Janssen,
Level Ex, Mayo Clinic, Medscape Cardiology, Merck, Mount Sinai
School of Medicine, MyoKardia, NirvaMed, Novartis, Novo Nordisk,
PhaseBio, PLx Pharma, Regado Biosciences, Population Health
Research Institute, and Stasys; serves as a trustee or director for
American College of Cardiology, AngioWave, Boston VA Research
Institute, Bristol Myers Squibb, DRS.LINQ, High Enroll, Society of
Cardiovascular Patient Care, and TobeSoft; has ownership interests in
AngioWave, Bristol Myers Squibb, DRS.LINQ, and High Enroll; has
other interests in Clinical Cardiology, the NCDR-ACTION Registry
Steering Committee; has conducted unfunded research with FlowCo
and Takeda, Contego Medical, American Heart Association Quality
Oversight Committee, Inaugural Chair, VA CART Research and Publications Committee; and has been a site co-investigator for Abbott,
Biotronik, Boston Scientific, CSI, St Jude Medical (now Abbott),
Phillips SpectraWAVE, Svelte, and Vascular Solutions. Dr Fuster declares that he raised $7 million from patients for this study granted to
Mount Sinai Heart, unrelated to industry. All other authors have reported that they have no relationships relevant to the contents of this
paper to disclose.S
Time trends in leisure time physical activity and physical fitness in elderly people: 20 year follow-up of the Spanish population national health survey (1987-2006)
<p>Abstract</p> <p>Background</p> <p>To estimate trends in leisure time physical activity and physical fitness between 1987-2006 in older Spanish people.</p> <p>Methods</p> <p>We analyzed data collected from the Spanish National Health Surveys conducted in 1987 (n = 29,647), 1993 (n = 20,707), 1995-1997 (n = 12,800), 2001 (n = 21,058), 2003 (n = 21,650), and 2006 (n = 29,478). The number of subjects aged â„ 65 years included in the current study was 29,263 (1987: n = 4,958-16.7%; 1993: n = 3,751-17.8%; 1995-97: n = 2,229-17.4%; 2001: n = 4,356-20.7%; 2003: 6,134-28.3%; 2006: 7,835-26.5%). Main variables included leisure-time physical activity and physical fitness. We analyzed socio-demographic characteristics, self-rated health status, lifestyle habit and co-morbid conditions using multivariate logistic regression models.</p> <p>Results</p> <p>Women exhibited lower prevalence of leisure time physical activity and physical fitness compared to men (P < 0.05). The multivariate analysis for time trends found that practising leisure time physical activity increased from 1987 to 2006 (P < 0.001). Variables associated with a lower likelihood of practicing leisure time physical activity were: age â„ 80 years old, â„ 2 co-morbid chronic conditions, and obesity. Variables associated with lower physical fitness included: age â„ 80 years, worse self rated health; â„ 2 medications (only for walking), and obesity.</p> <p>Conclusions</p> <p>We found an increase in leisure time physical activity in the older Spanish population. Older age, married status, co-morbid conditions, obesity, and worse self-perceived health status were associated with lower activity. Identification of these factors can help to identify individuals at risk for physical inactivity.</p
Ibero-American Consensus on Low- and No-Calorie Sweeteners: Safety, Nutritional Aspects and Benefits in Food and Beverages
International scientific experts in food, nutrition, dietetics, endocrinology, physical activity, paediatrics, nursing, toxicology and public health met in Lisbon on 2-4 July 2017 to develop a Consensus on the use of low- and no-calorie sweeteners (LNCS) as substitutes for sugars and other caloric sweeteners. LNCS are food additives that are broadly used as sugar substitutes to sweeten foods and beverages with the addition of fewer or no calories. They are also used in medicines, health-care products, such as toothpaste, and food supplements. The goal of this Consensus was to provide a useful, evidence-based, point of reference to assist in efforts to reduce free sugars consumption in line with current international public health recommendations. Participating experts in the Lisbon Consensus analysed and evaluated the evidence in relation to the role of LNCS in food safety, their regulation and the nutritional and dietary aspects of their use in foods and beverages. The conclusions of this Consensus were: (1) LNCS are some of the most extensively evaluated dietary constituents, and their safety has been reviewed and confirmed by regulatory bodies globally including the World Health Organisation, the US Food and Drug Administration and the European Food Safety Authority; (2) Consumer education, which is based on the most robust scientific evidence and regulatory processes, on the use of products containing LNCS should be strengthened in a comprehensive and objective way; (3) The use of LNCS in weight reduction programmes that involve replacing caloric sweeteners with LNCS in the context of structured diet plans may favour sustainable weight reduction. Furthermore, their use in diabetes management programmes may contribute to a better glycaemic control in patients, albeit with modest results. LNCS also provide dental health benefits when used in place of free sugars; (4) It is proposed that foods and beverages with LNCS could be included in dietary guidelines as alternative options to products sweetened with free sugars; (5) Continued education of health professionals is required, since they are a key source of information on issues related to food and health for both the general population and patients. With this in mind, the publication of position statements and consensus documents in the academic literature are extremely desirable
Epidemiological trends of HIV/HCV coinfection in Spain, 2015-2019
Altres ajuts: Spanish AIDS Research Network; European Funding for Regional Development (FEDER).Objectives: We assessed the prevalence of anti-hepatitis C virus (HCV) antibodies and active HCV infection (HCV-RNA-positive) in people living with HIV (PLWH) in Spain in 2019 and compared the results with those of four similar studies performed during 2015-2018. Methods: The study was performed in 41 centres. Sample size was estimated for an accuracy of 1%. Patients were selected by random sampling with proportional allocation. Results: The reference population comprised 41 973 PLWH, and the sample size was 1325. HCV serostatus was known in 1316 PLWH (99.3%), of whom 376 (28.6%) were HCV antibody (Ab)-positive (78.7% were prior injection drug users); 29 were HCV-RNA-positive (2.2%). Of the 29 HCV-RNA-positive PLWH, infection was chronic in 24, it was acute/recent in one, and it was of unknown duration in four. Cirrhosis was present in 71 (5.4%) PLWH overall, three (10.3%) HCV-RNA-positive patients and 68 (23.4%) of those who cleared HCV after anti-HCV therapy (p = 0.04). The prevalence of anti-HCV antibodies decreased steadily from 37.7% in 2015 to 28.6% in 2019 (p < 0.001); the prevalence of active HCV infection decreased from 22.1% in 2015 to 2.2% in 2019 (p < 0.001). Uptake of anti-HCV treatment increased from 53.9% in 2015 to 95.0% in 2019 (p < 0.001). Conclusions: In Spain, the prevalence of active HCV infection among PLWH at the end of 2019 was 2.2%, i.e. 90.0% lower than in 2015. Increased exposure to DAAs was probably the main reason for this sharp reduction. Despite the high coverage of treatment with direct-acting antiviral agents, HCV-related cirrhosis remains significant in this population
The global abundance of tree palms
Aim Palms are an iconic, diverse and often abundant component of tropical ecosystems that provide many ecosystem services. Being monocots, tree palms are evolutionarily, morphologically and physiologically distinct from other trees, and these differences have important consequences for ecosystem services (e.g., carbon sequestration and storage) and in terms of responses to climate change. We quantified global patterns of tree palm relative abundance to help improve understanding of tropical forests and reduce uncertainty about these ecosystems under climate change. Location Tropical and subtropical moist forests. Time period Current. Major taxa studied Palms (Arecaceae). Methods We assembled a pantropical dataset of 2,548 forest plots (covering 1,191 ha) and quantified tree palm (i.e., â„10 cm diameter at breast height) abundance relative to coâoccurring nonâpalm trees. We compared the relative abundance of tree palms across biogeographical realms and tested for associations with palaeoclimate stability, current climate, edaphic conditions and metrics of forest structure. Results On average, the relative abundance of tree palms was more than five times larger between Neotropical locations and other biogeographical realms. Tree palms were absent in most locations outside the Neotropics but present in >80% of Neotropical locations. The relative abundance of tree palms was more strongly associated with local conditions (e.g., higher mean annual precipitation, lower soil fertility, shallower water table and lower plot mean wood density) than metrics of longâterm climate stability. Lifeâform diversity also influenced the patterns; palm assemblages outside the Neotropics comprise many nonâtree (e.g., climbing) palms. Finally, we show that tree palms can influence estimates of aboveâground biomass, but the magnitude and direction of the effect require additional work. Conclusions Tree palms are not only quintessentially tropical, but they are also overwhelmingly Neotropical. Future work to understand the contributions of tree palms to biomass estimates and carbon cycling will be particularly crucial in Neotropical forests
International lower limb collaborative (INTELLECT) study: a multicentre, international retrospective audit of lower extremity open fractures
Trauma remains a major cause of mortality and disability across the world1, with a higher burden in developing nations2. Open lower extremity injuries are devastating events from a physical3, mental health4, and socioeconomic5 standpoint. The potential sequelae, including risk of chronic infection and amputation, can lead to delayed recovery and major disability6. This international study aimed to describe global disparities, timely intervention, guideline-directed care, and economic aspects of open lower limb injuries
Choice of the initial antiretroviral treatment for HIV-positive individuals in the era of integrase inhibitors
BACKGROUND: We aimed to describe the most frequently prescribed initial antiretroviral therapy (ART) regimens in recent years in HIV-positive persons in the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) and to investigate factors associated with the choice of each regimen. METHODS: We analyzed initial ART regimens prescribed in adults participating in CoRIS from 2014 to 2017. Only regimens prescribed in >5% of patients were considered. We used multivariable multinomial regression to estimate Relative Risk Ratios (RRRs) for the association between sociodemographic and clinical characteristics and the choice of the initial regimen. RESULTS: Among 2874 participants, abacavir(ABC)/lamivudine(3TC)/dolutegavir(DTG) was the most frequently prescribed regimen (32.1%), followed by tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC)/elvitegravir(EVG)/cobicistat(COBI) (14.9%), TDF/FTC/rilpivirine (RPV) (14.0%), tenofovir alafenamide (TAF)/FTC/EVG/COBI (13.7%), TDF/FTC+DTG (10.0%), TDF/FTC+darunavir/ritonavir or darunavir/cobicistat (bDRV) (9.8%) and TDF/FTC+raltegravir (RAL) (5.6%). Compared with ABC/3TC/DTG, starting TDF/FTC/RPV was less likely in patients with CD4100.000 copies/mL. TDF/FTC+DTG was more frequent in those with CD4100.000 copies/mL. TDF/FTC+RAL and TDF/FTC+bDRV were also more frequent among patients with CD4<200 cells//muL and with transmission categories other than men who have sex with men. Compared with ABC/3TC/DTG, the prescription of other initial ART regimens decreased from 2014-2015 to 2016-2017 with the exception of TDF/FTC+DTG. Differences in the choice of the initial ART regimen were observed by hospitals' location. CONCLUSIONS: The choice of initial ART regimens is consistent with Spanish guidelines' recommendations, but is also clearly influenced by physician's perception based on patient's clinical and sociodemographic variables and by the prescribing hospital location
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