Morphine in acute coronary syndrome : systematic review and meta-analysis

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Objective: Morphine is frequently used in acute coronary syndrome (ACS) due to its analgesic effect, it being recommended in the main cardiology guidelines in Europe and the USA. However, controversy exists regarding its routine use due to potential safety concerns. We conducted a systematic review of randomised-controlled trials (RCTs) and observational studies to synthesise the available evidence. Design: Systematic review and meta-analysis. Data sources: CENTRAL, MEDLINE, EMBASE and trial registries. Eligibility criteria for selecting studies: We included RCTs and observational studies evaluating the impact of morphine in cardiovascular outcomes or platelet reactivity measures. Data extraction and synthesis: Data were screened, extracted and appraised by two independent reviewers. The data were pooled results using a random-effects model. Outcomes included in-hospital mortality, major adverse cardiovascular events (MACE), platelet reactivity (using VerifyNow) and bleeding, reported as relative risk (RR) with 95%CI. We assessed the confidence in the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. We followed the Metaanalysis Of Observational Studies in Epidemiology and Preferred Reporting Items for Systematic Reviews and MetaAnalyses guidelines. Results: Five RCTs and 12 observational studies were included, enrolling 69 993 participants. Pooled results showed an increased risk of in-hospital mortality (RR 1.45 [95% CI 1.10 to 1.91], low GRADE confidence), MACE (RR 1.21, 95%CI 1.02 to 1.45) and an increased platelet reactivity at 1 and 2 hours (59.37 platelet reactivity units [PRU], 95%CI 36.04 to 82.71; 68.28 PRU, 95%CI 37.01 to 99.55, high GRADE confidence) associated with morphine. We found no significant difference in the risk of bleeding. We found no differences in subgroup analyses based on study design and ACS subtype. Conclusions: Morphine was associated with an increased risk of in-hospital mortality and MACE but the high risk of bias leads to low result confidence. There is high confidence that morphine decreases the antiplatelet effect of P2Y12 inhibitors.UID/BIM/50005/2019, project funded by Fundação para a Ciência e a Tecnologia (FCT)/ Ministério da Ciência, Tecnologia e Ensino Superior (MCTES) through Fundos do Orçamento de Estado.info:eu-repo/semantics/publishedVersio

CUIDADOS FARMACÊUTICOS APLICADOS AOS PACIENTES COM DIABETES MELLITUS TIPO 2 USUÁRIOS DE INSULINA: REVISÃO DA LITERATURA

Introduction: Diabetes Mellitus is characterized as a chronic and non-communicable metabolic disease, in which the individual's body produces a low amount of insulin or is unable to produce it. Objectives: With the aim of corroborating with previous studies, this research aims to understand the role of Pharmaceutical Care (PC) in relation to insulin-dependent patients with type 2 Diabetes Mellitus. Methods: Based on a qualitative literature review methodology, this study relied on research available on the Lilacs, Scielo, and Pubmed platforms, dated between January 2015 and July 2022. Results: The pharmacist has great importance in helping the treatment of patients with diabetes, specifically in aspects involving PA, since this professional can contribute for the rational use of medicines, in the analysis of specific cases in multidisciplinary care, in addition to minimizing the difficulties of pharmacotherapeutic treatment. It was noticed with the research, that pharmaceutical care is of great importance in the treatment of diabetics, as they can help in the transformation of habits, in addition to promoting significant improvements in the clinical conditions of patients, increasing the quality of life, in addition to promoting education. in patient-oriented health, for self-care practices.Introducción: La Diabetes Mellitus se caracteriza como una enfermedad metabólica crónica y no transmisible, en la cual el organismo del individuo produce una baja cantidad de insulina o es incapaz de producirla. Objetivos: Con el objetivo de respaldar los estudios ya realizados, esta investigación tiene como objetivo comprender el papel de la Asistencia Farmacéutica (AF) en relación con los pacientes dependientes de insulina que padecen Diabetes Mellitus tipo 2. Métodos: Basado en una metodología de revisión bibliográfica de enfoque cualitativo, este estudio se fundamentó en las investigaciones disponibles en las plataformas Lilacs, Scielo y Pubmed, con fechas comprendidas entre enero de 2015 y julio de 2022. Resultados: El farmacéutico desempeña un papel importante en el apoyo al tratamiento de pacientes con diabetes, especialmente en los aspectos relacionados con la AF, ya que este profesional puede contribuir al uso racional de medicamentos, al análisis de casos específicos en la atención multidisciplinaria, y a la minimización de las dificultades del tratamiento farmacoterapéutico. Se observó a través de la investigación que la atención farmacéutica es de gran importancia en el tratamiento de los diabéticos, ya que puede ayudar a transformar hábitos y promover mejoras significativas en la condición clínica de los pacientes, aumentando su calidad de vida, además de promover la educación en salud enfocada en el autocuidado del paciente.O Diabetes Mellitus é caracterizado como uma doença metabólica crônica e não transmissível, cujo organismo do indivíduo produz baixa quantidade ou é incapaz de produzir o hormônio insulina. Objetivos: visando corroborar com os estudos já elaborados, esta pesquisa tem como objetivo compreender a atuação da Assistência Farmacêutica (AF) em relação aos pacientes insulinodependentes que possuem Diabetes Mellitus tipo 2. Métodos: Pautado na metodologia de revisão bibliográfica de cunho qualitativo, esse estudo baseou-se nas pesquisas disponíveis nas plataformas Lilacs, Scielo e Pubmed, datados entre janeiro de 2015 a julho de 2022. Resultados: O farmacêutico possui uma grande importância no auxílio ao tratamento de pacientes com diabetes, especificamente nos aspectos que envolvem a AF, uma vez que esse profissional poderá contribuir para a utilização racional dos medicamentos, na análise de casos específicos no atendimento multidisciplinar, além de minimizar as dificuldades do tratamento farmacoterapêutico. Percebeu-se com a pesquisa, que os cuidados farmacêuticos são de grande importância no tratamento dos diabéticos, pois podem auxiliar na transformação de hábitos, além de promoverem melhoras significativas nos quadros clínicos dos pacientes, aumentando a qualidade de vida, além da promoção da educação em saúde voltada ao paciente, para as práticas de autocuidado.Introdução: O Diabetes Mellitus é caracterizado como uma doença metabólica crônica e não transmissível, cujo organismo do indivíduo produz baixa quantidade ou é incapaz de produzir o hormônio insulina. Objetivos: visando corroborar com os estudos já elaborados, esta pesquisa tem como objetivo compreender a atuação da Assistência Farmacêutica (AF) em relação aos pacientes insulinodependentes que possuem Diabetes Mellitus tipo 2. Métodos: Pautado na metodologia de revisão bibliográfica de cunho qualitativo, esse estudo baseou-se nas pesquisas disponíveis nas plataformas Lilacs, Scielo e Pubmed, datados entre janeiro de 2015 a julho de 2022. Resultados: O farmacêutico possui uma grande importância no auxílio ao tratamento de pacientes com diabetes, especificamente nos aspectos que envolvem a AF, uma vez que esse profissional poderá contribuir para a utilização racional dos medicamentos, na análise de casos específicos no atendimento multidisciplinar, além de minimizar as dificuldades do tratamento farmacoterapêutico. Percebeu-se com a pesquisa, que os cuidados farmacêuticos são de grande importância no tratamento dos diabéticos, pois podem auxiliar na transformação de hábitos, além de promoverem melhoras significativas nos quadros clínicos dos pacientes, aumentando a qualidade de vida, além da promoção da educação em saúde voltada ao paciente, para as práticas de autocuidado

MAMMALS IN PORTUGAL : A data set of terrestrial, volant, and marine mammal occurrences in P ortugal

Mammals are threatened worldwide, with 26% of all species being includedin the IUCN threatened categories. This overall pattern is primarily associatedwith habitat loss or degradation, and human persecution for terrestrial mam-mals, and pollution, open net fishing, climate change, and prey depletion formarine mammals. Mammals play a key role in maintaining ecosystems func-tionality and resilience, and therefore information on their distribution is cru-cial to delineate and support conservation actions. MAMMALS INPORTUGAL is a publicly available data set compiling unpublishedgeoreferenced occurrence records of 92 terrestrial, volant, and marine mam-mals in mainland Portugal and archipelagos of the Azores and Madeira thatincludes 105,026 data entries between 1873 and 2021 (72% of the data occur-ring in 2000 and 2021). The methods used to collect the data were: live obser-vations/captures (43%), sign surveys (35%), camera trapping (16%),bioacoustics surveys (4%) and radiotracking, and inquiries that represent lessthan 1% of the records. The data set includes 13 types of records: (1) burrowsjsoil moundsjtunnel, (2) capture, (3) colony, (4) dead animaljhairjskullsjjaws, (5) genetic confirmation, (6) inquiries, (7) observation of live animal (8),observation in shelters, (9) photo trappingjvideo, (10) predators dietjpelletsjpine cones/nuts, (11) scatjtrackjditch, (12) telemetry and (13) vocalizationjecholocation. The spatial uncertainty of most records ranges between 0 and100 m (76%). Rodentia (n=31,573) has the highest number of records followedby Chiroptera (n=18,857), Carnivora (n=18,594), Lagomorpha (n=17,496),Cetartiodactyla (n=11,568) and Eulipotyphla (n=7008). The data setincludes records of species classified by the IUCN as threatened(e.g.,Oryctolagus cuniculus[n=12,159],Monachus monachus[n=1,512],andLynx pardinus[n=197]). We believe that this data set may stimulate thepublication of other European countries data sets that would certainly contrib-ute to ecology and conservation-related research, and therefore assisting onthe development of more accurate and tailored conservation managementstrategies for each species. There are no copyright restrictions; please cite thisdata paper when the data are used in publications.info:eu-repo/semantics/publishedVersio

Mammals in Portugal: a data set of terrestrial, volant, and marine mammal occurrences in Portugal

Mammals are threatened worldwide, with ~26% of all species being included in the IUCN threatened categories. This overall pattern is primarily associated with habitat loss or degradation, and human persecution for terrestrial mammals, and pollution, open net fishing, climate change, and prey depletion for marine mammals. Mammals play a key role in maintaining ecosystems functionality and resilience, and therefore information on their distribution is crucial to delineate and support conservation actions. MAMMALS IN PORTUGAL is a publicly available data set compiling unpublished georeferenced occurrence records of 92 terrestrial, volant, and marine mammals in mainland Portugal and archipelagos of the Azores and Madeira that includes 105,026 data entries between 1873 and 2021 (72% of the data occurring in 2000 and 2021). The methods used to collect the data were: live observations/captures (43%), sign surveys (35%), camera trapping (16%), bioacoustics surveys (4%) and radiotracking, and inquiries that represent less than 1% of the records. The data set includes 13 types of records: (1) burrows | soil mounds | tunnel, (2) capture, (3) colony, (4) dead animal | hair | skulls | jaws, (5) genetic confirmation, (6) inquiries, (7) observation of live animal (8), observation in shelters, (9) photo trapping | video, (10) predators diet | pellets | pine cones/nuts, (11) scat | track | ditch, (12) telemetry and (13) vocalization | echolocation. The spatial uncertainty of most records ranges between 0 and 100 m (76%). Rodentia (n =31,573) has the highest number of records followed by Chiroptera (n = 18,857), Carnivora (n = 18,594), Lagomorpha (n = 17,496), Cetartiodactyla (n = 11,568) and Eulipotyphla (n = 7008). The data set includes records of species classified by the IUCN as threatened (e.g., Oryctolagus cuniculus [n = 12,159], Monachus monachus [n = 1,512], and Lynx pardinus [n = 197]). We believe that this data set may stimulate the publication of other European countries data sets that would certainly contribute to ecology and conservation-related research, and therefore assisting on the development of more accurate and tailored conservation management strategies for each species. There are no copyright restrictions; please cite this data paper when the data are used in publications

BacHBerry: BACterial Hosts for production of Bioactive phenolics from bERRY fruits

BACterial Hosts for production of Bioactive phenolics from bERRY fruits (BacHBerry) was a 3-year project funded by the Seventh Framework Programme (FP7) of the European Union that ran between November 2013 and October 2016. The overall aim of the project was to establish a sustainable and economically-feasible strategy for the production of novel high-value phenolic compounds isolated from berry fruits using bacterial platforms. The project aimed at covering all stages of the discovery and pre-commercialization process, including berry collection, screening and characterization of their bioactive components, identification and functional characterization of the corresponding biosynthetic pathways, and construction of Gram-positive bacterial cell factories producing phenolic compounds. Further activities included optimization of polyphenol extraction methods from bacterial cultures, scale-up of production by fermentation up to pilot scale, as well as societal and economic analyses of the processes. This review article summarizes some of the key findings obtained throughout the duration of the project

EPN-29THE ROLE OF RADIOTHERAPY IN PEDIATRIC EPENDYMOMAS - BEYOND ADJUVANT TREATMENT

Un’analisi del trattamento del tema della prostituzione nelle opere di Dacia Maraini pubblicate tra il 1962 e il 1999 (romanzi, racconti, opere teatrali, poesia e saggi). Sono state prese in considerazione le seguenti opere: La vacanza; L’età del malessere; Le mani; Il manifesto; Memorie di una ladra; Dialogo di una prostituta con un suo cliente; L’arte di amare; Prostituzione pubblica o privata?; Una casa di donne; Pazza d’amore; Prefazione a “Ritratto a tinte forti” di Carla Corso; Veronica, meretrice e scrittora; Voci; Corpo in vetrina; Viollca la bambina albanese

Nocebo response in Parkinson's disease : a systematic review and meta-analysis

© 2019 Elsevier Ltd. All rights reserved.Objective: To estimate the magnitude of the nocebo response in Parkinson's disease and explore possible associations with study characteristics. Methods: Databases were searched up to February 2017. Placebo-controlled, parallel-group randomized controlled trials investigating pharmacological interventions in people with Parkinson's disease were included. Data were derived from the last measured within-group response in the placebo and intervention arms of randomized controlled trials, after independent extraction. A random-effects model was used to pool study data. The main outcome was the nocebo response, measured as the proportion of placebo-treated participants experiencing any adverse events (AEs). We also measured the proportion of patients with serious AEs (SAEs), and the rates of study dropouts (including due to AEs) and death. PROSPERO registration number is CRD42017070471. Results: We included 236 randomized controlled trials, with a combined population of 17,381 participants allocated to placebo. The nocebo response was 56.0% (95% CI, 51.7%-60.4%; 148 trials; I2 = 98%). SAEs were reported in 4.0% (95% CI, 3.4%-4.6%, 157 trials; I2 = 73%) of placebo-treated patients, dropouts in 14.0% (95% CI, 12.5%-15.5%, 225 trials; I2 = 91%), dropouts due to AEs in 5.7% (95% CI, 5.1%-6.4%, 219 trials; I2 = 73%). Deaths occurred in 0.6% (95% CI, 0.5%-0.7%, 227 trials; I2 = 0%). Similar proportions were identified in patients in intervention arms. Conclusions: The magnitude of the nocebo response in parallel-designed randomized controlled trials in Parkinson's disease is substantial and should be considered in the interpretation of safety results and in the design and interpretation of future clinical trials.info:eu-repo/semantics/publishedVersio

Interrelationships among skeletal age, growth status and motor performances in female athletes 10–15 years

Motor performances of youth are related to growth and maturity status, among other factors. To estimate the contribution of skeletal maturity status per se to the motor performances of female athletes aged 10–15 years and the mediation effects of growth status on the relationships. Skeletal age (TW3 RUS SA), body size, proportions, estimated fat-free mass (FFM), motor performances, training history and participation motivation were assessed in 80 non-skeletally mature female participants in several sports. Hierarchical and regression-based statistical mediation analyses were used. SA per se explained a maximum of 1.8% and 5.8% of the variance in motor performances of athletes aged 10–12 and 13–15 years, respectively, over and above that explained by covariates. Body size, proportions, and hours per week of training and participation motivation explained, respectively, a maximum of 40.7%, 18.8%, and 22.6% of the variance in performances. Mediation analysis indicated specific indirect effects of SA through stature and body mass, alone or in conjunction with FFM on performances. SA per se accounted for small and non-significant amounts of variance in several motor performances of female youth athletes; rather, SA influenced performances indirectly through effects on stature, body mass and estimated FFM.</p