Demographics and clinical features of elderly patients undergoing regular dialysis in Brazil

An increasing number of elderly people in renal support is expected in the coming years. The objective of this study was to report the clinical and socio-demographic data of end-stage renal disease (ESRD) adult patients undergoing regular dialysis treatment comparing elderly (≥65 years old) and non-elderly subjects using data from the Brazilian Dialysis Registry database. The regional distribution of the sample was Southeast (48.8%), South (33.7), Northeast (13.1%), Midwest (5.1%), and North (0.1%). A total of 18,030 patients were included in the analysis with elderly patients accounting for 29.5% of the sample. The elderly patients were predominantly male, white, retired, and literate. Elderly ESRD patients had a slightly higher frequency of undernourishment and a lower frequency of obesity than the non-elderly adults. A higher frequency of elderly patients were from the South and Southeast regions. The dialysis treatment of patients from both groups was predominantly funded by the public system, but the percent of non-public funding was higher for the elderly group. The most used initial access in the elderly was the central venous catheter and hemodialysis was the main modality at the beginning of treatment (93.2%), as well as during maintenance therapy (91.8%). Advanced age was associated with greater use of central venous catheter in the first dialysis session. The survival of the elderly on dialysis was lower than that of the non-elderly early in the course of dialysis and this difference increased over time. This is yet the largest national epidemiological study of elderly people on chronic dialysis.     

Children’s,parents’, and other stakeholders’ perspectives on the factors influencing the initiation of early dietary change in the management of childhood chronic disease: a mixed studies systematic review using a narrative synthesis

BackgroundEarly dietary change can provide vital medical benefits supporting childhood chronic disease self-management.ObjectiveTo explore factors influencing the initiation of early dietary change in the management of childhood chronic disease, as described by children, parents’, and other stakeholders, to inform practice change in early paediatric service delivery.MethodsThis systematic review crossed seven databases from 2000-2018 to identify empirical research (qualitative, quantitative, and mixed-method designs), including grey literature. Methodological quality was appraised using validated scoring systems.ResultsSix studies met our criteria for inclusion in the review. Four themes of early dietary change emerged from these studies: (1) the role of education; (2) parents/caregivers’ roles; (3) the role of self-management, and the (4) identification of enablers and barriers to dietary change.ConclusionObtaining the perspectives of children, parents’ and other stakeholders’ on factors influencing early dietary change is key to the self-management of childhood chronic disease.Practice implicationsEarly dietary change provides an essential resource in the self-management of many chronic diseases. In collaboration, children, parents’ and healthcare professionals recognise the value of regular, engaging education, supported by workshops to empower and upskill, enabling change in everyday dietary habits, while using enablers and recognising challenges.     

Therapeutic effect of autologous concentrated growth factor on lower-extremity chronic refractory wounds: A case report

BACKGROUNDManagement of chronic refractory wounds is one of the toughest clinical challenges for surgeons. Because of poor blood supply, less tissue coverage, and easy exposure, the lower leg is a common site for chronic refractory wounds. The current therapeutic regimens often lead to prolonged hospital stay and higher healthcare costs. Concentrated growth factor (CGF) is a novel blood extract that contains various growth factors, platelets, and fibrins to promote wound healing process. However, there has been little research reported on the treatment of lower extremity wounds with CGF.CASE SUMMARYA 37-year-old man, without any past medical history, presented an ulcerated chronic wound on his right lower leg. The skin defect exhibited clear boundaries, with a size of 2.0 cm × 3.5 cm. The depth of wound was up to the layer of deep fascia. Staphylococcus aureus was detected by bacterial culture. The final diagnosis was right lower extremity ulcers with infection. Cefathiamidine, silver sulfadiazine, and mupirocin cream were applied to control the infection. CGF gel was prepared from the patient’s blood sample, and was used to cover the wound after thorough debridement. The skin wound was successfully healed after three times of CGF treatment.CONCLUSIONCGF displays an excellent wound healing promoting effect in patients with lower-extremity chronic refractory wounds.     

Corrigendum to “Probiotic mixture VSL#3: An overview of basic and clinical studies in chronic diseases”

Correction to: Cheng FS, Pan D, Chang B, Jiang M, Sang LX. Probiotic mixture VSL#3: An overview of basic and clinical studies in chronic diseases. World J Clin Cases 2020; 8: 1361-1384. We are the team of Min Jiang and Li-Xuan Sang from the First Affiliated Hospital, China Medical University. Now we solemnly declare that the studies mentioned in this article[1] evaluated the probiotic formulation known as VSL#3 before January 31, 2016. The probiotic formulation is now commonly referred to as De Simone Formulation. In addition, the product currently known as VSL#3 is not the same as De Simone Formulation. De Simone Formulation is now available as Visbiome in the United States and Vivomixx in Europe.     

Effect of an exercise program with blood flow restriction on the muscular strength of patients with chronic kidney disease: A randomized clinical trial

IntroductionAn arteriovenous fistula (AVF) is performed in chronic kidney disease (CKD) patients before hemodialysis, who may benefit from exercise. The aim of this study was to evaluate the effect of an exercise program associated with partial limb blood flow restriction (BFR) on handgrip strength (HGS) and forearm circumference of CKD patients.MethodsA total of 26 patients with CKD were randomized to the BFR experimental group (EG, n = 12) and to the non-BFR control group (CG, n = 14) prior to AVF, and underwent isometric exercises for the flexor muscles of the fingers and elbow where the AVF will be performed.ResultsThere were no differences at the end of eight weeks of training between the EG and CG groups [F (1.23) = 0.03, p = 0.96] regarding the HGS and the forearm circumference [F (1.23) = 0.90, p = 0.76], however muscle strength [F (1.23) = 189.84, p < 0.001] and forearm circumference [F (1.23) = 540.90, p < 0.001] improved between baseline and the results at the end of the program.ConclusionPartial BFR training was not superior to the CG for the outcomes evaluated in this study. Further studies should be conducted so that an indication of an exercise protocol for the evaluated outcomes is prescribed in order to be effectively offered in clinical practice.     

温肾散结方联合针刺治疗慢性骨盆疼痛综合征疗效分析

目的观察温肾散结方联合针刺治疗慢性骨盆疼痛综合征的临床疗效。方法选择2018年6月至2019年10月慢性骨盆疼痛综合征(CPPS)男性患者120例,根据随机数表分为对照组(盐酸特拉唑嗪片)、观察A组(温肾散结方)、观察B组(温肾散结方联合针刺),每组各40例,评估三组患者治疗前后的NIH-CPSI评分,比较其临床疗效。结果三组治疗后NIH-CPSI各项评分较治疗前均有所下降。观察A组的疼痛症状评分、排尿症状评分和NIH--CPSI总评分均低于对照组,差异有统计学意义(P<0.05);观察B组NIH-CPSI各项评分均低于对照组(P<0.05),疼痛症状评分及生活质量评分低于观察A组(P<0.05)。对照组总有效率为53.85%,观察A组为73.68%,观察B组为77.5%,差异有统计学意义(P<0.05)。结论温肾散结方联合针刺治疗CPPS具有良好的疗效,值得临床推广。