The Pull of Beauty The Storefront for Art and Architecture

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EFEITOS DA OZONIOTERAPIA COMPARADA A OUTRAS TERAPIAS PARA DOR LOMBAR: REVISÃO SISTEMÁTICA

Low back pain is a disease frequently observed in the adult population, and consequently directly affects the quality of life of the population. In order to provide an effective treatment, several therapies such as ozoniotherapy have been developed. The objective was to evaluate, from a systematic review, the effects of ozoniotherapy compared to other therapies for low back pain. In the systematic search for the basis of this study, the question of the acronym PICO was formulated: in patients with low back pain, can ozonotherapy, in comparison with other therapies, contribute positively to the treatment of pain? The following online search platforms were selected: Sciencedirect (Elsevier), PUBMED, and Scientific Electronic Library Online (SCIELO). Such bases were chosen due to their high impact in the area of medicine. Articles that presented relevance in relation to the theme and objective proposed in this study, publications of the last ten years, being available for download in Portuguese or English and randomized clinical trials were used. Ozone therapy has proved to be a good option for such treatment when compared to other methods. The patients treated with ozonotherapy presented significant recovery. Therefore, it is important to promote access to this integrative and complementary therapy within the Unified Health System.La lumbalgia es una enfermedad que se observa con frecuencia en la población adulta y, en consecuencia, afecta directamente a la calidad de vida de la población. Para proporcionar un tratamiento eficaz, se han desarrollado varias terapias, como la ozonoterapia. El objetivo es evaluar, a partir de una revisión sistemática, los efectos de la ozonoterapia en comparación con otras terapias para el dolor lumbar. Al realizar la búsqueda sistemática de las bases de este estudio, se formuló la pregunta PICO: en pacientes con lumbalgia, ¿puede la ozonoterapia, en comparación con otras terapias, contribuir positivamente al tratamiento del dolor? Se seleccionaron las siguientes plataformas de búsqueda en línea: ScienceDirect (Elsevier), PUBMED y Scientific Electronic Library Online (SCIELO). Estas bases de datos fueron elegidas por su alto impacto en el área de la medicina. Se utilizaron artículos relevantes para el tema y el objetivo propuesto en este estudio, publicados en los últimos diez años, disponibles para su descarga en portugués o inglés, y ensayos clínicos aleatorios. La ozonoterapia ha demostrado ser una buena opción para dicho tratamiento en comparación con otros métodos. Los pacientes tratados con ozonoterapia mostraron una recuperación significativa. Por ello, es importante promover el acceso a esta terapia integradora y complementaria dentro del Sistema Único de Salud.  Il mal di schiena è una malattia frequentemente osservata nella popolazione adulta, e di conseguenza colpisce direttamente la qualità della vita della popolazione. Al fine di fornire un trattamento efficace, sono state sviluppate diverse terapie, come l'ozonoterapia. L'obiettivo è stato quello di valutare, a partire da una revisione sistematica, gli effetti dell'ozonoterapia rispetto ad altre terapie per il dor lombar. Nel condurre la ricerca sistematica alla base di questo studio, è stata formulata la domanda acronimo PICO: nei pazienti con dolore lombare, l'ozonoterapia, rispetto ad altre terapie, può contribuire positivamente al trattamento del dolore? Sono state selezionate le seguenti piattaforme di ricerca online: ScienceDirect (Elsevier), PUBMED, e Scientific Electronic Library Online (SCIELO). Questi database sono stati scelti per il loro alto impatto nell'area della medicina. Abbiamo utilizzato articoli pertinenti al tema e all'obiettivo proposto in questo studio, pubblicati negli ultimi dieci anni, disponibili per il download in portoghese o in inglese, e studi clinici randomizzati. L'ozonoterapia ha dimostrato di essere una buona opzione per questo tipo di trattamento rispetto ad altri metodi. I pazienti trattati con l'ozonoterapia hanno mostrato un recupero significativo. Pertanto, è importante promuovere l'accesso a questa terapia integrativa e complementare all'interno del Sistema Sanitario Unificato.  A lombalgia é uma enfermidade frequentemente observada na população adulta, e consequentemente afeta diretamente a qualidade de vida da população. Com intuito de apresentar um tratamento eficaz, desenvolveram-se várias terapias como a ozonioterapia. Objetivou-se avaliar, a partir de uma revisão sistemática, os efeitos da ozonioterapia comparada a outras terapias para dor lombar. Na realização da busca sistemática para fundamentação do presente estudo, foi formulada a questão do acrônimo PICO: em pacientes com lombalgia, a ozonoterapia, em comparação com outras terapias, pode contribuir positivamente no tratamento de dor? Foram selecionadas as plataformas de buscas online: ScienceDirect (Elsevier), PUBMED, e Scientific Electronic Library Online (SCIELO). Optou-se por tais bases, devido ao alto impacto das mesmas na área da medicina. Utilizaram-se artigos que apresentassem relevância com relação ao tema e objetivo proposto neste estudo, publicações dos últimos dez anos, estar disponível para download em português ou inglês e ensaios clínicos randomizados. A ozonoterapia mostrou-se uma boa opção para tal tratamento, quando se comparada a outros métodos. Os pacientes tratados com ozonoterapia apresentaram recuperação significativa. Portanto, é importante promover o acesso a esta terapia integrativa e complementar no âmbito do Sistema Único de Saúde

USO DA METFORMINA COM ÊNFASE EM PACIENTES CARDÍACOS

Treatment with metformin is known to significantly improve glucose control in people with type 2 diabetes, with no weight gain and negligible risk of hypoglycemia. In addition, metformin treatment appears to be associated with a lower risk of cardiovascular disease and morbidity. Thus, we aimed to perform a systematic review regarding the use of metformin in the treatment of cardiac patients. This is a systematic review of the literature. To do so, the literature reference selection method was ProKnow-C. The PICO acronym question was: In cardiac patients, can the use of metformin contribute to the treatment of this group? The following uncontrolled terms were used to search the material: "cardiac abnormality", "cardiac treatment", "metformin in cardiac patients". Regarding the inclusion criteria, we included articles published in national and international languages, in the time interval 2010-2021 and that were freely available in the platforms of the National Library of Medicine U.S (NLM/PUBMED), ScienceDirect (Elsevier) and Scientific Electronic Library Online (SciELO). Although metformin is used as a form of treatment in several clinical cases, some authors still claim that there are worrisome results regarding the incidence of cardiovascular deaths. Due to the instability of the articles under analysis, it is suggested by the authors of this study that more clinical trials be carried out in order to consolidate the effects of this drug in patients with cardiovascular problems.Se sabe que el tratamiento con metformina mejora significativamente el control de la glucosa en personas con diabetes de tipo 2, sin aumento de peso y con un riesgo insignificante de hipoglucemia. Además, el tratamiento con metformina parece estar asociado a un menor riesgo de enfermedad y morbilidad cardiovascular. Por lo tanto, este estudio tuvo como objetivo realizar una revisión sistemática sobre el uso de la metformina en el tratamiento de pacientes cardíacos. Se trata de una revisión sistemática de la literatura. Para ello, el método de selección de la referencia bibliográfica fue ProKnow-C. La pregunta del acrónimo PICO fue: En pacientes cardíacos, ¿puede el uso de metformina contribuir al tratamiento de este grupo? Para la búsqueda de material se utilizaron los siguientes términos no controlados: "cardiac abnormality", "cardiac treatment", "metformin in cardiac patients". En cuanto a los criterios de inclusión, se incluyeron artículos publicados en idiomas nacionales e internacionales, en el intervalo de tiempo 2010-2021 y que estuvieran disponibles de forma gratuita en las plataformas de la National Library of Medicine U.S (NLM/PUBMED), ScienceDirect (Elsevier) y Scientific Electronic Library Online (SciELO). Aunque la metformina se utiliza como forma de tratamiento en varios casos clínicos, algunos autores siguen afirmando que existen resultados preocupantes en cuanto a la incidencia de muertes cardiovasculares. Debido a la inestabilidad de los artículos analizados, los autores de este estudio sugieren que se realicen más ensayos clínicos para consolidar los efectos de este medicamento en pacientes con problemas cardiovasculares.  Il trattamento con metformina è noto per migliorare significativamente il controllo del glucosio nelle persone con diabete di tipo 2, senza aumento di peso e con un rischio trascurabile di ipoglicemia. Inoltre, il trattamento con metformina sembra essere associato a un minor rischio di malattie cardiovascolari e di morbilità. Così, questo studio ha cercato di eseguire una revisione sistematica sull'uso della metformina nel trattamento dei pazienti cardiaci. Questa è una revisione sistematica della letteratura. Per fare ciò, il metodo di selezione del riferimento bibliografico è stato ProKnow-C. La domanda dell'acronimo PICO era: nei pazienti cardiopatici, l'uso della metformina può contribuire al trattamento di questo gruppo? Per cercare il materiale, sono stati utilizzati i seguenti termini non controllati: "anomalia cardiaca", "trattamento cardiaco", "metformina in pazienti cardiaci". Per quanto riguarda i criteri di inclusione, abbiamo incluso articoli pubblicati in lingue nazionali e internazionali, nell'intervallo di tempo 2010-2021 e che erano liberamente disponibili nelle piattaforme della National Library of Medicine U.S (NLM/PUBMED), ScienceDirect (Elsevier) e Scientific Electronic Library Online (SciELO). Anche se la metformina è utilizzata come forma di trattamento in diversi casi clinici, alcuni autori sostengono ancora che ci sono risultati preoccupanti per quanto riguarda l'incidenza di morti cardiovascolari. A causa dell'instabilità degli articoli in analisi, gli autori di questo studio suggeriscono di realizzare più studi clinici per consolidare gli effetti di questo farmaco nei pazienti con problemi cardiovascolari.  Sabe-se que o tratamento com metformina melhora de forma significativa o controle da glicose em pessoas com diabetes tipo 2, sem ganho de peso e riscos insignificantes de hipoglicemia. Além disso, o tratamento com metformina parece associar-se a um menor risco de doenças cardiovasculares e morbidade. Desta forma, objetivou-se realizar uma revisão sistemática a respeito do uso da metformina no tratamento de pacientes cardíacos. Trata-se de uma revisão sistemática da literatura. Para tanto, utilizou-se o método de seleção do referencial bibliográfico foi ProKnow-C. A questão do acrônimo PICO foi: em pacientes cardíacos, o uso da metformina pode contribuir com o tratamento desse grupo? Para busca de material, utilizaram-se os seguintes termos não controlados: “anormalidade cardíaca”, “tratamento cardíaco”, “metformina em cardíacos”. Com relação aos critérios de inclusão, foram incluídos artigos publicados em língua nacional e internacional, no intervalo de tempo de 2010-2021 e que estivessem disponíveis gratuitamente nas plataformas da National Library of Medicine U.S (NLM/PUBMED), ScienceDirect (Elsevier) e Scientific Electronic Library Online (SciELO). Apesar de a metformina ser utilizada como forma de tratamento em vários casos clínicos, alguns autores ainda afirmam que existe resultados preocupantes em relação à incidência de mortes cardiovasculares. Devido as instabilidades dos artigos em analise, é sugerida pelos autores deste estudo, a realização de mais ensaios clínicos, para consolidar os efeitos deste medicamento em pacientes com problemas cardiovasculares

Intravenous human umbilical cord-derived mesenchymal stromal cell administration in models of moderate and severe intracerebral hemorrhage

Intracerebral hemorrhage (ICH) is as a life-threatening condition that can occur in young adults, often causing long-term disability. Recent preclinical data suggests mesenchymal stromal cell (MSC)-based therapies as promising options to minimize brain damage after ICH. However, therapeutic evidence and mechanistic insights are still limited, particularly when compared to other disorders such as ischemic stroke. Herein, we employed a model of collagenase-induced ICH in young adult rats to investigate the potential therapeutic effects of an intravenous injection of human umbilical cord Wharton's jelly-derived MSCs (hUC-MSCs). Two doses of collagenase were used to cause moderate or severe hemorrhages. Magnetic resonance imaging showed that animals treated with hUC-MSCs after moderate ICH had smaller residual hematoma volumes than vehicle-treated rats, whereas the cell therapy failed to decrease the hematoma volume in animals with a severe ICH. Functional assessments (rotarod and elevated body swing tests) were performed for up to 21 days after ICH. Enduring neurological impairments were seen only in animals subjected to severe ICH, but the cell therapy did not induce statistically significant improvements in the functional recovery. The biodistribution of Technetium-99m-labeled hUC-MSCs was also evaluated, showing that most cells were found in organs such as the spleen and lungs 24 h after transplantation. Nevertheless, it was possible to detect a weak signal in the brain, which was higher in the ipsilateral hemisphere of rats subjected to a severe ICH. These data indicate that hUC-MSCs have moderately beneficial effects in cases of less severe brain hemorrhages in rats by decreasing the residual hematoma volume, and that optimization of the therapy is still necessary

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake