Comorbidity burden in terms of disability in patients with osteoarthritis in Mexico. The IMPACTAR registry

ObjectiveTo determine the comorbidities associated with disability in patients with OA in Mexico (2013–2015).Material and methodsA cross-sectional, retrospective and multicentre IMPACTAR study (n = 7703) in Mexican patients (2013–2015). Comorbidities associated with disability were identified in 4971 patients diagnosed with OA from the IMPACTAR registry (n = 7073). An adjusted logistic regression analysis was carried out by demographic, economic, clinical and medical variables.ResultsMean age was 63 years; and 75% of the patients were women. Subjects with OA and presence of comorbidities are 42% more likely to develop disabilities than patients without associated comorbidity, considering age, sex, family income, OA diagnosis duration, and education level. The highest rate of people with disability (28.9%) was concentrated in Region 7, which corresponds to Mexico City. There are also significant differences between median family incomes, when the income of persons with disability is under $13 000 (IQR: 9000–16 000) Mexican pesos, compared to patients without disability. Almost half of the subjects (49.6%) reported having at least one comorbidity. Arterial hypertension was the risk factor with a statistically significant difference (32.8%) among those with disability (34.7%).ConclusionsPrograms and interventions for OA patients should take into consideration comorbidity factors, being female, family income, and the region of residence as variables that may increase the possibility of developing an OA-associated disability.     

The trues behind TRUS in the setting of chronic prostatitis/chronic pelvic pain syndrome

ObjectiveWe sought to explore the yield of transrectal ultrasound (TRUS) in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).Materials and methodsThe records of all patients, who were referred for TRUS caused by CP/CPPS, were retrospectively reviewed. Digital rectal examination (DRE) was performed before TRUS. The following parameters were recorded: prostatic length; width; height; volume; external border; peripheral zone (PZ); transitional zone (TZ); TZ/PZ border; seminal vesicles appearance (SV); presence of median lobe; dilation of vas deferens (VD) or ejaculatory duct (ED); and presence of significant postvoid residual (PVR). Unique sonographic findings, if present, were recorded as well. Data were compared to those of an age-matched control group that had undergone the same imaging for other reasons.ResultsTwo hundred and sixteen patients with suspected CP/CPPS underwent DRE and TRUS. Per DRE, their prostates appeared smaller and homogeneous compared with the control group. Differences seen in TRUS between the study and the control groups, respectively, were as follows: fewer irregularities, fewer hypoechoic areas in PZ; fewer cystic spaces, fewer enlarged median lobes in TZ; less ED dilation; more calcifications; more VD dilation; and more periurethral vascularity. No differences were seen in SV parameters and in PVR. None of the patients has been given different diagnosis or treatment following TRUS.ConclusionThe findings of TRUS studies in patients with suspected CP/CPPS are not pathognomonic for this entity, and TRUS is therefore considered as having very little yield in this setting.     

Fascia-iliaca compartment block vs intra-articular hip injection for preoperative pain management in intracapsular hip fractures: A blind,randomized, controlled trial

BackgroundThe aim of this study was to compare the fascia-iliaca compartment block and the intra-articular hip injection in terms of pain management and the need for additional systemic analgesia in the preoperative phase of intracapsular hip fractures.MethodsPatients >65 years old with an intracapsular hip fracture were randomized in this prospective, blind, controlled, parallel trial in a Level-I trauma center. Patients were randomly assigned to receive either the fascia-iliaca compartment block (cohort FICB) or the intra-articular hip injection (cohort IAHI) upon admission to the emergency department. The primary outcome was pain relief at 20 min, 12 h, 24 h and 48 h after the regional anesthesia, both at rest and during internal rotation of the fractured limb. The Numeric Rating Scale was used. Residual pain was managed with the same protocol in all patients. Additional analgesic drug administration during the 48 h from admission was recorded.ResultsA total of 120 patients with comparable baseline characteristics were analyzed in this study: the FICB group consisted of 70 subjects, while the IAHI group consisted of 50 subjects.Pain was significantly lower in the IAHI group during movement of the fractured limb at 20 min (p < 0.05), 12 h (p < 0.05), 24 h (p < 0.05) and 48 h (p < 0.05).In the FICB cohort 72.9% of patients needed to take oxycodone, in contrast to 28.6% of the IAHI cohort (p < 0.05). In the FICB cohort 14.09 ± 11.57 mg of oxycodone was administered, while in the IAHI cohort 4.38 ± 7.63 mg (p < 0.05). No adverse events related to either technique were recorded.ConclusionsIntra-articular hip injection provides better pre-operatory pain management in elder patients with intracapsular hip fractures compared to the fascia-iliaca compartment block. It also reduced the need for supplementary systemic analgesia.Level of EvidenceTherapeutic Level I.     

Analysis of quantitative and qualitative measures of attachment in patients with fibromyalgia: The influence on nursing care

Attachment has been associated to fibromyalgia; however, this relationship has not been studied from the perspective of nursing care. In this study, in which 146 women with fibromyalgia participated, higher scores for anxiety and depression were found among those with fearful attachment. Additionally, attachment, as a quantitative measure, has also been associated to the functional limitation of the patients. Therefore, we propose the inclusion of attachment in the care of patients with fibromyalgia.     

局麻与硬膜外麻醉下聚丙烯材料补片应用腹股沟疝修补术效果及慢性疼痛调查——基层医院经验

目的对比分析局麻与硬外麻醉下无张力修补术治疗腹股沟疝疗效,探讨基层医院在有限条件下治疗腹股沟疝更适宜的麻醉方式。方法采用前瞻性研究方法,纳入研究的患者为2016年7月至2017年1月半年来收治的102例腹股沟疝所有患者分成局麻组与硬外麻组,两组均采用疝囊高位结扎+平片无张力修补术,比较两组手术时间、术后伤口疼痛时间、术后不良反应和并发症的发生和差异;记录术后患者对麻醉效果的满意度;出院后嘱病人1周后回院复查1次,1个月、6个月、12个月、24个月电话随访1次。结果两组皮下血肿、术后伤口感染、阴囊肿胀、腹股沟神经与腹腔脏器损伤、术后伤口疼痛时间差异无统计学意义(P0.05),局麻组住院时间、住院费用、恶心/呕吐、头昏/头痛、尿潴留并发症发生率均比硬外麻组低或少,两组差异有统计学意义(P0.05)。两组患者在2年随访中各有2例出现腹股沟区疼痛,服用NSAIDs类药物好转。两组术后1月、6月、12月和24月VAS评分结果,其差异没有统计学意义(表3)。两组患者对手术中麻醉满意情况见表4,硬膜外组满意患者多于局麻组。结论基层医院实施局麻下开放式腹股沟疝平片无张力修补术可行,也不增加慢性疼痛的发生。     

硫酸镁联合银杏达莫治疗慢性肺源性心脏病的疗效观察

目的探讨硫酸镁联合银杏达莫治疗慢性肺源性心脏病的疗效。方法将笔者所在医院2011年3月～2012年3月72例慢性肺源性心脏病患者随机分成对照组和治疗组,对照组患者进行常规的抗感染、保持呼吸道通畅、利尿、扩张血管、纠正电解质平衡等治疗;治疗组在对照组的基础上加用硫酸镁和银杏达莫。观察两组患者治疗前后心功能、肺动脉收缩压的改善情况,并进行临床观察分析。结果治疗组的总有效率明显高于对照组,差异有统计学意义(P<0.05)。结论硫酸镁联合银杏达莫治疗慢性肺源性心脏病疗效显著,临床上建议进一步推广运用。     

Editorial: The integration of pharmacological and nonpharmacological treatments in drug/alcohol addiction

No abstract available for this article.     

基于网络药理学及分子对接研究苦参治疗慢性乙型肝炎的作用机制＊

目的 本研究通过网络药理学及分子对接方法研究苦参治疗慢性乙型肝炎的物质基础与分子机制。方法 依据中药系统药理学数据库和分析平台（TCMSP）筛选苦参有效化学成分及靶点基因。检索GeneCards数据库及OMIM数据库获取慢性乙型肝炎（CHB）相关靶点基因。采用Cytoscape3.7.2构建苦参治疗CHB的“相关活性成分-潜在作用靶点”网络并进行拓扑结构分析，利用STRING平台进行蛋白质相互作用分析，构建PPI网络，通过R 3.6.2进行基因富集分析。依据AutoDock vina将关键活性成分与核心靶点进行分子对接。结果 获得苦参治疗CHB的相关活性成分23个，潜在作用靶点97个。网络分析结果提示苦参可能通过作用于IL-6、ESR1、AR、RELA、PPARG和CASP3 6个核心靶点及相关通路以达到治疗CHB的目的。分子对接预测结果提示关键活性成分与核心靶点稳定结合。结论 本研究初步揭示了苦参治疗慢性乙型肝炎多成分、多靶点、多通路的作用机制，为苦参的临床开发提供基础。