Pub Date : 2025-01-01DOI: 10.1016/j.clinsp.2025.100598
Ana Claudia Marcelino , Paula da Cunha Pereira , Luis Bahamondes
The incorporation of long-acting reversible contraceptives (LARCs) into reproductive health strategies is crucial for enhancing access to effective contraception and reducing unplanned pregnancies (UPs). Evidence shows that even a modest shift from short-acting methods to LARCs can yield significant cost savings and improve health outcomes, both for individuals and public health systems. By facilitating single-visit placements and expanding the training of multidisciplinary teams, including nurses, healthcare providers can increase access to these effective contraceptive options.
{"title":"The economic impact of Long-Acting Contraceptives (LARCs) on public health","authors":"Ana Claudia Marcelino , Paula da Cunha Pereira , Luis Bahamondes","doi":"10.1016/j.clinsp.2025.100598","DOIUrl":"10.1016/j.clinsp.2025.100598","url":null,"abstract":"<div><div>The incorporation of long-acting reversible contraceptives (LARCs) into reproductive health strategies is crucial for enhancing access to effective contraception and reducing unplanned pregnancies (UPs). Evidence shows that even a modest shift from short-acting methods to LARCs can yield significant cost savings and improve health outcomes, both for individuals and public health systems. By facilitating single-visit placements and expanding the training of multidisciplinary teams, including nurses, healthcare providers can increase access to these effective contraceptive options.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100598"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143438091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.clinsp.2025.100586
Dhianey de Almeida Neves , Leonardo Costa Pereira , Kerolyn Ramos Garcia , Frederico Santos de Santana , Rhenan Yoshio de Caldas Fujita , Beatriz dos Santos Faria , José Antônio Alves de Oliveira , Carlos James Zeidan Silva Filho , Margô Gomes de Oliveira Karnikowski
Introduction
One of the parameters observed in functional capacity over the years is the decrease in neuromuscular responses, a fact that is attributed to the contemporary lifestyle. Thus, there is a need to carry out interventions that induce the improvement of functional capacity. Some studies have associated electrostimulation (NMES) with Strength Training (ST) to enhance the results in improving neuromuscular function. However, little is known about the effects of this association due to the numerous protocols to be manipulated. Furthermore, adaptive responses to strength training are dependent on volume and intensity manipulation.
Objective
To investigate the influence of ST, concomitant with NMES (NMES+) on functional capacity.
Methods
This is a systematic review with meta-analysis. For the search of the articles, descriptors associated with functional capacity and NMES+ were selected in the Cochrane, PubMed, Embase and VHL meta-searcher databases. Inclusion criteria were articles that presented neuromuscular electrostimulation superimposed on voluntary contraction and ST intensity control; and that did not have a therapeutic purpose. The analysis of titles, abstracts and data extraction were performed by trios of reviewers. To assess the qualities of scientific evidence, the risk of bias was analyzed through the ROB2 tool, meta- analysis and evaluation of the quality of evidence (GRADE).
Results
This meta-analysis selected 3 studies. The main outcomes observed in the studies were agility, balance, cardiorespiratory capacity and strength and power. A significant improvement in effect estimates for cardiorespiratory capacity alone was observed between the two studies.
Conclusion
Despite the significant effect of the use of NMES+, in relation to ST in isolation, the quality of the evidence was considered low, probably due to the limited number of scientific evidence found, requiring further studies to identify the real effect of this association.
{"title":"Impact of the association of strength training with neuromuscular electrostimulation on the functionality of individuals with functional decline during senescence: A systematic review and meta-analysis","authors":"Dhianey de Almeida Neves , Leonardo Costa Pereira , Kerolyn Ramos Garcia , Frederico Santos de Santana , Rhenan Yoshio de Caldas Fujita , Beatriz dos Santos Faria , José Antônio Alves de Oliveira , Carlos James Zeidan Silva Filho , Margô Gomes de Oliveira Karnikowski","doi":"10.1016/j.clinsp.2025.100586","DOIUrl":"10.1016/j.clinsp.2025.100586","url":null,"abstract":"<div><h3>Introduction</h3><div>One of the parameters observed in functional capacity over the years is the decrease in neuromuscular responses, a fact that is attributed to the contemporary lifestyle. Thus, there is a need to carry out interventions that induce the improvement of functional capacity. Some studies have associated electrostimulation (NMES) with Strength Training (ST) to enhance the results in improving neuromuscular function. However, little is known about the effects of this association due to the numerous protocols to be manipulated. Furthermore, adaptive responses to strength training are dependent on volume and intensity manipulation.</div></div><div><h3>Objective</h3><div>To investigate the influence of ST, concomitant with NMES (NMES+) on functional capacity.</div></div><div><h3>Methods</h3><div>This is a systematic review with meta-analysis. For the search of the articles, descriptors associated with functional capacity and NMES+ were selected in the Cochrane, PubMed, Embase and VHL meta-searcher databases. Inclusion criteria were articles that presented neuromuscular electrostimulation superimposed on voluntary contraction and ST intensity control; and that did not have a therapeutic purpose. The analysis of titles, abstracts and data extraction were performed by trios of reviewers. To assess the qualities of scientific evidence, the risk of bias was analyzed through the ROB2 tool, meta- analysis and evaluation of the quality of evidence (GRADE).</div></div><div><h3>Results</h3><div>This meta-analysis selected 3 studies. The main outcomes observed in the studies were agility, balance, cardiorespiratory capacity and strength and power. A significant improvement in effect estimates for cardiorespiratory capacity alone was observed between the two studies.</div></div><div><h3>Conclusion</h3><div>Despite the significant effect of the use of NMES+, in relation to ST in isolation, the quality of the evidence was considered low, probably due to the limited number of scientific evidence found, requiring further studies to identify the real effect of this association.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100586"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.clinsp.2025.100608
Gabriela Pravatta-Rezende , Cristina Laguna Benetti-Pinto , Daniela Angerame Yela Gomes , Ana Carolina Japur de Sá Rosa e Silva , José Maria Soares Junior
Objective
To provide a protocol for the diagnosis and management of Acute Abnormal Uterine Bleeding (AUB) during menacme, addressing common causes, clinical evaluation, and treatment options.
Methods
A review of current evidence and guidelines was performed to create a structured approach for healthcare professionals.
Results
Acute AUB, defined as excessive uterine bleeding unrelated to pregnancy, requires immediate intervention. Causes vary by age and include coagulopathies, anovulation, and structural anomalies. Clinical stability, lab workups, and imaging are pivotal in guiding management. Initial treatment focuses on hemodynamic stabilization followed by medical therapies such as antifibrinolytics, hormonal agents, or surgical intervention when necessary.
Conclusion
Early intervention in AUB ensures optimal outcomes, reduces complications, and allows transition to maintenance therapy to prevent recurrence.
{"title":"Diagnosis and management of acute abnormal uterine bleeding during menacme","authors":"Gabriela Pravatta-Rezende , Cristina Laguna Benetti-Pinto , Daniela Angerame Yela Gomes , Ana Carolina Japur de Sá Rosa e Silva , José Maria Soares Junior","doi":"10.1016/j.clinsp.2025.100608","DOIUrl":"10.1016/j.clinsp.2025.100608","url":null,"abstract":"<div><h3>Objective</h3><div>To provide a protocol for the diagnosis and management of Acute Abnormal Uterine Bleeding (AUB) during menacme, addressing common causes, clinical evaluation, and treatment options.</div></div><div><h3>Methods</h3><div>A review of current evidence and guidelines was performed to create a structured approach for healthcare professionals.</div></div><div><h3>Results</h3><div>Acute AUB, defined as excessive uterine bleeding unrelated to pregnancy, requires immediate intervention. Causes vary by age and include coagulopathies, anovulation, and structural anomalies. Clinical stability, lab workups, and imaging are pivotal in guiding management. Initial treatment focuses on hemodynamic stabilization followed by medical therapies such as antifibrinolytics, hormonal agents, or surgical intervention when necessary.</div></div><div><h3>Conclusion</h3><div>Early intervention in AUB ensures optimal outcomes, reduces complications, and allows transition to maintenance therapy to prevent recurrence.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100608"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143579987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.clinsp.2025.100664
Xia Sun , Lujia Zhang , Yan Pan , Kaiji Ni , Chenfeng Ji , Qian Zhou , Scott Stuart , Yanli Luo
Background
Generalized Anxiety Disorder (GAD) is a common and disabling psychiatric disorder that negatively impairs patients' quality of life. Studies suggest that inadequate consideration of interpersonal problems may contribute to the poor treatment response in psychotherapy for GAD. Interpersonal Psychotherapy (IPT) is an evidence-based psychosocial intervention that focuses on symptoms by improving interpersonal functioning, and research demonstrates that IPT is efficacious in treating social anxiety and panic disorders. To date, however, there are no studies examining IPT for patients with GAD.
Methods
The authors developed and pilot-tested an IPT manual for the treatment of GAD in groups with two cohorts of patients. Pre- and post-test measures of anxiety were collected and analyzed.
Results
The authors successfully developed a treatment manual for Group IPT for Anxiety using iterative qualitative methods. Significant improvement from baseline was noted in the GAD scores for patients in both patient cohorts.
Conclusions
The results suggest that IPT can be successfully used for GAD in group formats and that future large-scale randomized trials should be warranted. The results also suggest that online group therapy is feasible and warrants further study and that it may be used to deal with access and logistical barriers faced by many patients.
{"title":"Group interpersonal psychotherapy for generalized anxiety disorder: development process and a pilot test","authors":"Xia Sun , Lujia Zhang , Yan Pan , Kaiji Ni , Chenfeng Ji , Qian Zhou , Scott Stuart , Yanli Luo","doi":"10.1016/j.clinsp.2025.100664","DOIUrl":"10.1016/j.clinsp.2025.100664","url":null,"abstract":"<div><h3>Background</h3><div>Generalized Anxiety Disorder (GAD) is a common and disabling psychiatric disorder that negatively impairs patients' quality of life. Studies suggest that inadequate consideration of interpersonal problems may contribute to the poor treatment response in psychotherapy for GAD. Interpersonal Psychotherapy (IPT) is an evidence-based psychosocial intervention that focuses on symptoms by improving interpersonal functioning, and research demonstrates that IPT is efficacious in treating social anxiety and panic disorders. To date, however, there are no studies examining IPT for patients with GAD.</div></div><div><h3>Methods</h3><div>The authors developed and pilot-tested an IPT manual for the treatment of GAD in groups with two cohorts of patients. Pre- and post-test measures of anxiety were collected and analyzed.</div></div><div><h3>Results</h3><div>The authors successfully developed a treatment manual for Group IPT for Anxiety using iterative qualitative methods. Significant improvement from baseline was noted in the GAD scores for patients in both patient cohorts.</div></div><div><h3>Conclusions</h3><div>The results suggest that IPT can be successfully used for GAD in group formats and that future large-scale randomized trials should be warranted. The results also suggest that online group therapy is feasible and warrants further study and that it may be used to deal with access and logistical barriers faced by many patients.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100664"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143869818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laryngeal Squamous Cell Carcinoma (LSCC) may be treated clinically or surgically as a therapeutic option with a curative intention. The aim of this study is to compare direct medical costs and overall survival associated with the treatment of LSCC.
Methods
Retrospective cost-consequence analysis, from the perspective of a Brazilian public hospital that included patients with LSCC, from 2014 to 2017. Unit costs were estimated using a macro-costing approach. The Propensity Score Matching method was used. Survival analyses were performed using the Kaplan-Meier method.
Results
The therapeutic modalities were similar in terms of total costs: USD 32,259.65 for the clinical group and USD 34,385.87 for the surgical group (p = 0.215). Patients in the surgical group showed better overall survival than the clinical group (HR 0.53; p = 0.047).
Conclusion
Both therapeutic modalities for the treatment of LSCC showed similar total costs. Nevertheless, overall survival was better in the surgical group.
{"title":"Cost-consequence analysis of surgical and clinical treatment modalities of laryngeal cancer","authors":"Alexandre Bezerra dos Santos , Patrícia Coelho de Soárez , Rossana Veronica Mendoza Lopez , Luciana Martins Rozman , Alessandro Gonçalves Campolina","doi":"10.1016/j.clinsp.2025.100585","DOIUrl":"10.1016/j.clinsp.2025.100585","url":null,"abstract":"<div><h3>Background</h3><div>Laryngeal Squamous Cell Carcinoma (LSCC) may be treated clinically or surgically as a therapeutic option with a curative intention. The aim of this study is to compare direct medical costs and overall survival associated with the treatment of LSCC.</div></div><div><h3>Methods</h3><div>Retrospective cost-consequence analysis, from the perspective of a Brazilian public hospital that included patients with LSCC, from 2014 to 2017. Unit costs were estimated using a macro-costing approach. The Propensity Score Matching method was used. Survival analyses were performed using the Kaplan-Meier method.</div></div><div><h3>Results</h3><div>The therapeutic modalities were similar in terms of total costs: USD 32,259.65 for the clinical group and USD 34,385.87 for the surgical group (p = 0.215). Patients in the surgical group showed better overall survival than the clinical group (HR 0.53; p = 0.047).</div></div><div><h3>Conclusion</h3><div>Both therapeutic modalities for the treatment of LSCC showed similar total costs. Nevertheless, overall survival was better in the surgical group.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100585"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.clinsp.2025.100648
Constantino López-Macías , Eduardo López-Medina , Maysa Bonfleur Alves , Aline da Rocha Matos , Juan V. Hernández-Villena , Zuleika Aponte-Torres , Laura E. Sarabia , Paula Manrique-Ramirez , Luis F. Tejado-Gallegos , Larisa Ramirez Gutierrez , Wilhelmine Meeraus , Bárbara Emoingt Furtado
Objectives
COVID-19 vaccines prevented severe disease outcomes worldwide. As part of a vaccine effectiveness study, the authors summarized demographic and health profiles, vaccination data, SARS-CoV-2 variants, and disease outcomes from patients hospitalized due to COVID-19-like symptoms in Latin America between February and December 2022.
Methods
LIVE was an observational-prospective study with a test-negative case-control design (NCT05282017). Adults admitted with COVID-19-like symptoms were recruited across five Latin American countries. Patients were tested for SARS-CoV-2, and variants were identified through sequencing. Data were collected from medical records and interviews.
Results
Participants recruited (536 cases, 250 controls) had a mean age of 60.5 years. COVID-19 cases (63.7, SD = 19.1) were slightly older than controls (53.8, SD = 20.4). Disorders of the cardiovascular system were the most prevalent comorbidities, and most participants (73.0 %) reported at least one comorbidity. COVID-19 cases mostly presented with moderate (51.1 %) disease. Overall, 50.6 % of participants were unvaccinated against COVID-19, with a higher percentage in cases (56.3 %) than in controls (38.2 %). Viral genomic analysis identified the most prevalent SARS-CoV-2 lineages, BQ.1.1 (11.9 %) among Omicron BA.5 and XBB.1.15 (2.5 %) among recombinant variants. The study was underpowered to estimate vaccine effectiveness due to the low number of COVID-19 hospitalization cases.
Conclusion
The present study revealed key demographic and clinical characteristics of patients hospitalized due to COVID-19. Notably, an older age among confirmed cases, a substantial proportion of unvaccinated individuals, and the decrease in hospitalizations emphasize the complexity of the COVID-19 landscape in Latin America and the need for continued research to inform public health strategies.
{"title":"Clinical characteristics, SARS-CoV-2 variants, and outcomes of adults hospitalized due to COVID-19 in Latin American countries","authors":"Constantino López-Macías , Eduardo López-Medina , Maysa Bonfleur Alves , Aline da Rocha Matos , Juan V. Hernández-Villena , Zuleika Aponte-Torres , Laura E. Sarabia , Paula Manrique-Ramirez , Luis F. Tejado-Gallegos , Larisa Ramirez Gutierrez , Wilhelmine Meeraus , Bárbara Emoingt Furtado","doi":"10.1016/j.clinsp.2025.100648","DOIUrl":"10.1016/j.clinsp.2025.100648","url":null,"abstract":"<div><h3>Objectives</h3><div>COVID-19 vaccines prevented severe disease outcomes worldwide. As part of a vaccine effectiveness study, the authors summarized demographic and health profiles, vaccination data, SARS-CoV-2 variants, and disease outcomes from patients hospitalized due to COVID-19-like symptoms in Latin America between February and December 2022.</div></div><div><h3>Methods</h3><div>LIVE was an observational-prospective study with a test-negative case-control design (NCT05282017). Adults admitted with COVID-19-like symptoms were recruited across five Latin American countries. Patients were tested for SARS-CoV-2, and variants were identified through sequencing. Data were collected from medical records and interviews.</div></div><div><h3>Results</h3><div>Participants recruited (536 cases, 250 controls) had a mean age of 60.5 years. COVID-19 cases (63.7, SD = 19.1) were slightly older than controls (53.8, SD = 20.4). Disorders of the cardiovascular system were the most prevalent comorbidities, and most participants (73.0 %) reported at least one comorbidity. COVID-19 cases mostly presented with moderate (51.1 %) disease. Overall, 50.6 % of participants were unvaccinated against COVID-19, with a higher percentage in cases (56.3 %) than in controls (38.2 %). Viral genomic analysis identified the most prevalent SARS-CoV-2 lineages, BQ.1.1 (11.9 %) among Omicron BA.5 and XBB.1.15 (2.5 %) among recombinant variants. The study was underpowered to estimate vaccine effectiveness due to the low number of COVID-19 hospitalization cases.</div></div><div><h3>Conclusion</h3><div>The present study revealed key demographic and clinical characteristics of patients hospitalized due to COVID-19. Notably, an older age among confirmed cases, a substantial proportion of unvaccinated individuals, and the decrease in hospitalizations emphasize the complexity of the COVID-19 landscape in Latin America and the need for continued research to inform public health strategies.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100648"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.clinsp.2024.100574
Fereshteh Ashtari , Arshia Ghalamkari , Saba Naghavi , Ahmad Pourmohammadi , Iman Adibi , Zahra Karimi , Aryan Kavosh
Objectives
It is estimated that up to 65 % of pwMS (people with multiple sclerosis) experience varying degrees of cognitive impairment, the most commonly affected domain being Information Processing Speed (IPS). As sleep disturbance is a predictor of detriments in IPS, the authors aimed to study the association between the severity of Restless Legs Syndrome (RLS) and Obstructive Sleep Apnea (OSA) symptoms with IPS in pwMS.
Methods
In a cross-sectional study, the authors enrolled people with relapsing-remitting and secondary progressive MS referred to the comprehensive MS center of Kashani Hospital in Isfahan, Iran. The authors used Berlin and STOP-Bang questionnaires for assessing OSA symptoms, and the International Restless Legs Syndrome Study Group (IRLSSG) scale for the presence and severity of symptoms of RLS. The authors used the Integrated Cognitive Assessment (ICA) test, a language and education-independent tool, to assess visual processing speed.
Results
The authors included 211 pwMS, with a mean age of 36.73 ± 8.9 (81.9 % female). PwMS with higher RLS scores showed lower IPS, with ICA indexes of 0.66 ± 0.09 vs. 0.61 ± 0.12 in low- and high-risk RLS groups, respectively (p < 0.01). There were no significant associations between IPS as measured by the ICA index and OSA symptom severity.
Conclusion
The authors found impairments in IPS in pwMS to be linked with the severity of RLS symptoms, but not with OSA. Considering the high prevalence and underdiagnosis of RLS in pwMS, and the profound impact of IPS on quality of life, this association highlights the importance of screening and treating RLS in this population.
{"title":"Relationship between sleep disorders and information processing speed in multiple sclerosis","authors":"Fereshteh Ashtari , Arshia Ghalamkari , Saba Naghavi , Ahmad Pourmohammadi , Iman Adibi , Zahra Karimi , Aryan Kavosh","doi":"10.1016/j.clinsp.2024.100574","DOIUrl":"10.1016/j.clinsp.2024.100574","url":null,"abstract":"<div><h3>Objectives</h3><div>It is estimated that up to 65 % of pwMS (people with multiple sclerosis) experience varying degrees of cognitive impairment, the most commonly affected domain being Information Processing Speed (IPS). As sleep disturbance is a predictor of detriments in IPS, the authors aimed to study the association between the severity of Restless Legs Syndrome (RLS) and Obstructive Sleep Apnea (OSA) symptoms with IPS in pwMS.</div></div><div><h3>Methods</h3><div>In a cross-sectional study, the authors enrolled people with relapsing-remitting and secondary progressive MS referred to the comprehensive MS center of Kashani Hospital in Isfahan, Iran. The authors used Berlin and STOP-Bang questionnaires for assessing OSA symptoms, and the International Restless Legs Syndrome Study Group (IRLSSG) scale for the presence and severity of symptoms of RLS. The authors used the Integrated Cognitive Assessment (ICA) test, a language and education-independent tool, to assess visual processing speed.</div></div><div><h3>Results</h3><div>The authors included 211 pwMS, with a mean age of 36.73 ± 8.9 (81.9 % female). PwMS with higher RLS scores showed lower IPS, with ICA indexes of 0.66 ± 0.09 vs. 0.61 ± 0.12 in low- and high-risk RLS groups, respectively (p < 0.01). There were no significant associations between IPS as measured by the ICA index and OSA symptom severity.</div></div><div><h3>Conclusion</h3><div>The authors found impairments in IPS in pwMS to be linked with the severity of RLS symptoms, but not with OSA. Considering the high prevalence and underdiagnosis of RLS in pwMS, and the profound impact of IPS on quality of life, this association highlights the importance of screening and treating RLS in this population.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100574"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.clinsp.2024.100540
Jennifer Nakamura Ruas , Ernesto Quaresma Mendonça , Luciano Lenz , Gustavo Andrade de Paulo , Ricardo Uemura Sato , José Jukemura , Ulysses Ribeiro Junior , Fauze Maluf-Filho , Bruno Costa Martins
Background and aim
Malignant hilar obstruction usually presents in advanced-stage disease with a poor prognosis. Effective biliary drainage is essential for the beginning of palliative chemotherapy. There is a debate on the amount of liver parenchyma that should be drained to achieve clinical success. This study aimed to correlate the volume of liver drained with clinical success rate.
Methods
The authors conducted a retrospective study including patients with malignant hilar biliary obstruction who underwent retrograde endoscopic cholangiography for biliary drainage from January 2014 to December 2018. The main outcome was a correlation of clinical success rate with hepatic volume drained. Secondary outcomes were correlation of clinical success rate with the quantity of liver sectors drained and unilateral versus bilateral drainage.
Results
82 patients met inclusion criteria (58.5 % female), with a mean age of 60±13 years. The main cause of hilar obstruction was cholangiocarcinoma (32.9 %) followed by lymph node metastasis (23.2 %). Technical success was achieved in 75 patients (91.5 %), and clinical success in 45 patients (60 %). The authors found a significant correlation between clinical success rate when at least 50 % of viable parenchyma was drained (p = 0.016; OR = 4.15, 95 % CI 1.4–12.5). Considering liver sectors, higher clinical success rates were found when at least 2 sectors were drained (p < 0.001; OR = 8.50, 95 % CI 2.7–26.7). The correlation between unilateral versus bilateral drainage and clinical success was not statistically significant.
Conclusion
Drainage of at least 50 % of volume hepatic parenchyma was associated with better outcomes as well as drainage of at least 2 hepatic sectors, regardless of if unilateral or bilateral.
背景与目的：恶性肺门梗阻常见于疾病晚期，预后较差。有效的胆道引流对于姑息性化疗的开始是必不可少的。有一个争论的肝实质的数量，应该引流，以取得临床成功。本研究旨在探讨肝引流容量与临床成功率之间的关系。方法：回顾性分析2014年1月至2018年12月行逆行胆道内镜下胆道造影引流的恶性肝门胆道梗阻患者。主要观察结果是临床成功率与肝容量引流的相关性。次要结果是临床成功率与引流肝段数量、单侧与双侧引流的相关性。结果：82例患者符合纳入标准（58.5%为女性），平均年龄60±13岁。肝门梗阻的主要原因是胆管癌（32.9%），其次是淋巴结转移（23.2%）。技术成功75例（91.5%），临床成功45例（60%）。作者发现，当至少50%的活实质被抽干时，临床成功率显著相关(p = 0.016；Or = 4.15, 95% ci 1.4-12.5)。考虑到肝脏各部分，当至少有2个部分引流时，临床成功率更高(p < 0.001；Or = 8.50, 95% ci 2.7-26.7)。单侧引流与双侧引流与临床成功率的相关性无统计学意义。结论：无论单侧还是双侧，至少50%肝实质体积引流和至少2个肝段引流均可获得较好的预后。
{"title":"Correlation between liver volume drainage and clinical success after endoscopic biliary drainage of hilar malignant obstruction","authors":"Jennifer Nakamura Ruas , Ernesto Quaresma Mendonça , Luciano Lenz , Gustavo Andrade de Paulo , Ricardo Uemura Sato , José Jukemura , Ulysses Ribeiro Junior , Fauze Maluf-Filho , Bruno Costa Martins","doi":"10.1016/j.clinsp.2024.100540","DOIUrl":"10.1016/j.clinsp.2024.100540","url":null,"abstract":"<div><h3>Background and aim</h3><div>Malignant hilar obstruction usually presents in advanced-stage disease with a poor prognosis. Effective biliary drainage is essential for the beginning of palliative chemotherapy. There is a debate on the amount of liver parenchyma that should be drained to achieve clinical success. This study aimed to correlate the volume of liver drained with clinical success rate.</div></div><div><h3>Methods</h3><div>The authors conducted a retrospective study including patients with malignant hilar biliary obstruction who underwent retrograde endoscopic cholangiography for biliary drainage from January 2014 to December 2018. The main outcome was a correlation of clinical success rate with hepatic volume drained. Secondary outcomes were correlation of clinical success rate with the quantity of liver sectors drained and unilateral versus bilateral drainage.</div></div><div><h3>Results</h3><div>82 patients met inclusion criteria (58.5 % female), with a mean age of 60±13 years. The main cause of hilar obstruction was cholangiocarcinoma (32.9 %) followed by lymph node metastasis (23.2 %). Technical success was achieved in 75 patients (91.5 %), and clinical success in 45 patients (60 %). The authors found a significant correlation between clinical success rate when at least 50 % of viable parenchyma was drained (p = 0.016; OR = 4.15, 95 % CI 1.4–12.5). Considering liver sectors, higher clinical success rates were found when at least 2 sectors were drained (p < 0.001; OR = 8.50, 95 % CI 2.7–26.7). The correlation between unilateral versus bilateral drainage and clinical success was not statistically significant.</div></div><div><h3>Conclusion</h3><div>Drainage of at least 50 % of volume hepatic parenchyma was associated with better outcomes as well as drainage of at least 2 hepatic sectors, regardless of if unilateral or bilateral.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100540"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11650313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.clinsp.2024.100569
Pedro Fernandes Ribeiro, Bianca Ramos, Tallys A. Suzuki, Giovanna Uyeda
{"title":"Comments on the article “Olanzapine as a prophylactic antiemetic for preventing postoperative nausea and vomiting after general anesthesia: A systematic review and meta-analysis”","authors":"Pedro Fernandes Ribeiro, Bianca Ramos, Tallys A. Suzuki, Giovanna Uyeda","doi":"10.1016/j.clinsp.2024.100569","DOIUrl":"10.1016/j.clinsp.2024.100569","url":null,"abstract":"","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100569"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.clinsp.2024.100555
Priscila Costa Estabile, Márcia Saldanha Kubrusly, Robson Kiyoshi Ishida, André Bubna Hirayama, Roberto de Cleva, Marco Aurelio Santo
Background
Individuals with severe obesity and type 2 diabetes mellitus have reduced secretion of incretins by L cells. Studies suggest an increase in L cell activity according to the length of the Biliopancreatic Loop (BPL).
Objective
Compare the effect of biliopancreatic loop extension on the number and expression of L cells in patients undergoing RYGB
Methods
Subjects (n = 13) undergoing RYGB with a BPL of 100 cm (G1) or 200 cm (G2). Intestinal biopsies were done before (T1) and 6 months after (T2) RYGB in 3 segments: gastro-enteric anastomosis (A), entero-enteric anastomosis (B) and terminal ileum (C). Analyzes of intestinal biopsies by immunohistochemistry and qRT-PCR.
Results
There was an increase (p < 0.0001) in L cells marked by PYY and GLP1 between T1 (17 ± 10.5) and T2 (23.5 ± 10.7) only at point C. There was no difference in L cells expression between groups G1 and G2 at points A (A1: 17.3 ± 2.9; A2: 19.9 ± 1.9; p = 0.09), B (B1: 13.7 ± 6.6; B2: 14.1 ± 4.9; p = 0.89) and C (C1: 13.2 ± 2.2; C2: 11.4 ± 3.4; p = 0.32) in PYY and GLP1 gene expression (A1: 20.8 ± 4, 1; A2: 23.7 ± 3.6; p = 0.2), B (B1:14.3 ± 7.9; B2: 22.7 ± 11.8; p = 0.1), (C1: 17±4.1; C2: 21.1 ± 4.8; p = 0.2).
Conclusions
Both techniques lead to an increase in the number of active L cells.
{"title":"Evaluation of l-cell activity in the small intestine according to the extension of the biliopancreatic loop in patients undergoing Roux-en-Y gastric by-pass","authors":"Priscila Costa Estabile, Márcia Saldanha Kubrusly, Robson Kiyoshi Ishida, André Bubna Hirayama, Roberto de Cleva, Marco Aurelio Santo","doi":"10.1016/j.clinsp.2024.100555","DOIUrl":"10.1016/j.clinsp.2024.100555","url":null,"abstract":"<div><h3>Background</h3><div>Individuals with severe obesity and type 2 diabetes mellitus have reduced secretion of incretins by L cells. Studies suggest an increase in L cell activity according to the length of the Biliopancreatic Loop (BPL).</div></div><div><h3>Objective</h3><div>Compare the effect of biliopancreatic loop extension on the number and expression of L cells in patients undergoing RYGB</div></div><div><h3>Methods</h3><div>Subjects (<em>n</em> = 13) undergoing RYGB with a BPL of 100 cm (G1) or 200 cm (G2). Intestinal biopsies were done before (T1) and 6 months after (T2) RYGB in 3 segments: gastro-enteric anastomosis (A), entero-enteric anastomosis (B) and terminal ileum (C). Analyzes of intestinal biopsies by immunohistochemistry and qRT-PCR.</div></div><div><h3>Results</h3><div>There was an increase (<em>p</em> < 0.0001) in L cells marked by PYY and GLP1 between T1 (17 ± 10.5) and T2 (23.5 ± 10.7) only at point C. There was no difference in L cells expression between groups G1 and G2 at points A (A1: 17.3 ± 2.9; A2: 19.9 ± 1.9; <em>p</em> = 0.09), B (B1: 13.7 ± 6.6; B2: 14.1 ± 4.9; <em>p</em> = 0.89) and C (C1: 13.2 ± 2.2; C2: 11.4 ± 3.4; <em>p</em> = 0.32) in PYY and GLP1 gene expression (A1: 20.8 ± 4, 1; A2: 23.7 ± 3.6; <em>p</em> = 0.2), B (B1:14.3 ± 7.9; B2: 22.7 ± 11.8; <em>p</em> = 0.1), (C1: 17±4.1; C2: 21.1 ± 4.8; <em>p</em> = 0.2).</div></div><div><h3>Conclusions</h3><div>Both techniques lead to an increase in the number of active L cells.</div></div>","PeriodicalId":10472,"journal":{"name":"Clinics","volume":"80 ","pages":"Article 100555"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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