Risultati per: Gestione dei sintomi del tratto urinario inferiore femminili (LUTS - Lower Urinary Tract Symptoms)

Mixed urinary incontinence presents a clinical conundrum. Patients with mixed urinary incontinence report symptoms of both stress incontinence (loss of urine with exertion) and urge incontinence (loss of urine with urgency). Mixed urinary incontinence is a combination of the two that affects 37% of women older than age 65 years. The personal and societal costs of incontinence are significant. In women with symptoms of severe urinary incontinence, the cost of supplies, laundry, and dry cleaning range from $900 to $4000 annually. By 80 years of age, 20% of women will undergo surgery for stress or mixed urinary incontinence. Physical and behavioral therapy improves both incontinence types, and medications are standard treatment for urgency urinary incontinence. When conservative therapies fail, conventional guidance has been to treat the urgency prior to the stress component of mixed incontinence, because anti-incontinence surgical procedures can worsen urgency incontinence, and many urgency treatments are medical rather than surgical. Another strategy has been to treat whichever symptom is dominant.

This clinical trial compares the efficacy of intradetrusor onabotulinumtoxinA vs midurethral sling for the treatment of mixed urinary incontinence in females.

Although glucagon-like peptide-1 (GLP-1) receptor agonists are primarily intended for managing type 2 diabetes (T2D) and obesity, research continues to uncover additional benefits. The latest exploration suggests that GLP-1 medications may help lower dementia risk.

New England Journal of Medicine, Ahead of Print.

This case series evaluates the safety and efficacy of IL-5 inhibition for the treatment of drug reaction with eosinophilia and systemic symptoms.

Introduction
The COVID-19 pandemic, driven by the SARS-CoV-2 virus, has had a significant global impact, with over 775 million cases reported and more than 7 million deaths as of July 2024. In Chile, approximately 5.4 million people have been infected, with a substantial proportion experiencing persistent symptoms known as post-COVID-19 syndrome. This study aims to estimate the prevalence of post-COVID-19 syndrome in Punta Arenas, Chile, and to explore the associated symptoms, mainly focusing on psychological, physical and molecular impacts on the affected population.

Methods and analysis
This cross-sectional study will use stratified random sampling to select a representative sample of 282 adults from Punta Arenas. Participants eligible for the study are those who had tested positive for SARS-CoV-2 by reverse transcription-quantitative PCR between July 2022 and July 2023. Data collection will include comprehensive clinical assessments, psychological evaluations and laboratory analyses of inflammatory biomarkers. Standardised instruments will be used to ensure consistency and reliability in measuring persistent symptoms. Statistical analyses will include descriptive statistics, regression models and subgroup analyses to identify risk factors and the prevalence of post-COVID-19 syndrome.

Ethics and dissemination
The Human Research Ethics Committee of the Clinical Hospital of the University of Chile approved the study protocol (Memorandum No 007/2023). We will present the results in peer-reviewed publications and national and international professional and academic meetings.

Trial registration number
NCT05855382.

Introduction
Intensive care unit-acquired weakness (ICUAW) is a common and severe complication in critically ill patients, associated with high morbidity and poor prognosis. Despite increasing focus on ICUAW, definitive diagnostic and therapeutic strategies remain absent. Early mobilisation has been demonstrated as an effective intervention for preventing and alleviating ICUAW. This study aims to evaluate the early-stage efficacy of suspended lower-limb rehabilitation robot-assisted therapy in patients with ICUAW.

Methods and analysis
This study is a self-controlled randomised trial aiming to include 60 patients with ICUAW. Each patient’s lower limbs will be randomly assigned to either the experimental group or the control group. The control group will receive standard rehabilitation therapy, while the experimental group will receive additional suspended lower-limb rehabilitation robot-assisted therapy alongside standard care. The intervention will be delivered for 40 min daily, 5 days per week, over a 2-week period. The primary outcome measure is the thickness of key lower-limb muscles assessed via musculoskeletal ultrasound. Secondary outcome measures include the Medical Research Council score, range of motion of the lower-limb joints, and limb circumference. Data will be collected at baseline, after 1 week of intervention and at the 2-week endpoint.

Ethics and dissemination
This study has received ethical approval from the Research Ethics Committee of Changhai Hospital, affiliated with the Naval Medical University (approval reference: CHEC2023-055). Written informed consent will be obtained from all participants prior to their inclusion in the study. The findings, including both positive and negative outcomes, will be disseminated through publication in international peer-reviewed journals and presentation at relevant academic conferences.

Trial registration number
ChiCTR2300070118.

Alla Camera documento con fondazione Onda, ‘approccio integrato’

Objective
Antimicrobial resistance is a significant global health challenge, exacerbated by unnecessary antibiotic prescribing. Respiratory tract infections (RTIs) are common reasons for antibiotic prescribing in primary care, despite most being viral or bacterial infections that are self-limiting. C-reactive protein (CRP) point-of-care tests (POCTs) are promising tools to support antibiotic stewardship by guiding the management of lower RTIs (LRTIs). The aim of this study was to develop best practice guidance for using CRP POCT in the management of LRTIs in primary care.

Design
Scoping review findings informed guidance statements, which were then evaluated through a three-round Delphi process with an expert panel via web-based questionnaires. Statements focused on intended use, detection of bacterial LRTIs, communication strategies, device features, performance and ease of use of CRP POCT.

Setting and participants
The panel of experts included 19 healthcare professionals across several specialties, including general practitioners, community pharmacists, hospital pharmacists and respiratory physicians.

Main outcome measures
Panellists rated each guidance statement using a 5-point Likert scale, with acceptance, revision or rejection determined using predefined cut-off scores for medians and interquartile ranges. Statements were revised between rounds using the feedback provided by panellists.

Results
In the first round, 49 statements were evaluated; 16 were accepted, nine removed and 24 revised for the second round. Of the 24 statements evaluated in the second round, 17 were accepted and seven were revised. In the third round, consensus was reached on four of the seven statements presented, resulting in 37 final guidance statements. These statements covered key areas, including the appropriate use of CRP POCTs to guide antibiotic prescribing, CRP cut-off values, integration with clinical decision rules, device performance and operational considerations, training requirements and financial reimbursement. The panel emphasised the need for structured guidelines to align CRP POCT use with clinical context and highlighted its role in improving diagnostic confidence while supporting antibiotic stewardship.

Conclusions
This study provides a set of best practice guidance statements to support the use of CRP POCT in the management of LRTIs in primary care. Dissemination and further research are required to assess their impact.

Background
Musculoskeletal injury (MSKI) is the leading cause of medical downgrading and discharge within the UK military, with lower limb MSKI having the greatest incidence, negatively impacting operational readiness. Pain is a primary limiting factor to rehabilitation progress following MSKI. Heavy-load resistance training (RT; ie, loads >70% 1-repetition maximum) is traditionally used but may be contraindicated due to pain, potentially prolonging recovery and leading to failure of essential physical employment standards for UK military personnel. Low-load RT with blood flow restriction (BFR) can promote favourable morphological and physiological adaption, as well as elicit hypoalgesia in healthy and clinical populations (eg, post-operative), and has proven a viable option in military rehabilitation settings. The acceptability and tolerance of higher relative BFR pressures in persistent pain populations are unknown due to the complexity of presentation and the perception of discomfort experienced during BFR exercise. Greater relative pressures (ie, 80% limb occlusion pressure (LOP)) elicit a greater hypoalgesic response in pain-free individuals, but greater perceived discomfort which may not be tolerated in persistent pain populations. However, lower relative pressure (ie, 40% LOP) has elicited hypoalgesia in pain-free individuals, which therefore may be more clinically acceptable and tolerated in persistent pain populations. The primary aim of both randomised controlled trials (RCT) is to investigate the efficacy and acceptability of using high-frequency, low-load BFR-RT in UK military personnel with lower limb MSKI where persistent pain is the primary limiting factor for progression.

Methodology
The presented protocol is a two-phase RCT based within a military rehabilitation setting. Phase One is a 1-week RCT to determine the most efficacious and acceptable BFR-RT protocol (7x BFR-RT sessions over 5 days at 40% or 80% LOP; n=28). Phase Two is a 3-week RCT comparing the most clinically acceptable BFR pressure, determined by Phase One (21x BFR-RT sessions over 15 days; n=26) to usual care within UK Defence Rehabilitation residential rehabilitation practices. Outcomes will be recorded at baseline, daily and following completion of the intervention. The primary outcome will be the brief pain inventory. Secondary outcomes include blood biomarkers for inflammation and pain (Phase Two only), injury-specific outcome measures, lower extremity function scale, objective measures of muscle strength and neuromuscular performance, and pressure pain threshold testing.

Ethics and dissemination
The study is approved by the Ministry of Defence Research Ethics Committee (2318/MODREC/24) and Northumbria University. All study findings will be published in scientific peer-reviewed journals and presented at relevant scientific conferences.

Trial registration number
Registered with Clinical Trials. The registration numbers are as follows: NCT06621914 (Phase One) and NCT06621953 (Phase Two).

Objective
The current study aimed to compare the relationship between polycyclic aromatic hydrocarbons (PAHs) exposure and thyroid hormone (TH) sensitivity markers in individuals with normal thyroid function in the USA population during 2007–2008 and 2009–2012.

Design
Observational cross-sectional study.

Setting
US population data from 2007 to 2008 and 2009 to 2012.

Main outcome measures
Associations between PAH exposure and TH sensitivity were examined, stratified by sex and age, along with dose–response relationships between PAH metabolites and TH sensitivity indices.

Results
In women, after adjusting for confounding variables, 1-hydroxynaphthalene was positively associated with thyroid feedback quantile index of FT4 (TFQIFT4) (β=0.0072, 95% CI 0.0018 to 0.0127, p=0.022), thyrotropin thyroxine resistance index (TT4RI) (β=0.0099, 95% CI 0.0024 to 0.0173, p=0.021) and thyroid-stimulating hormone index (TSHI) (β=0.0107, 95% CI 0.0038 to 0.0176, p=0.012). Among individuals aged 60 years and older, 1-hydroxyphenanthrene was negatively associated with free triiodothyronine/free thyroxine (FT3/FT4) (β = –0.9328, 95% CI –1.5055 to –0.3602, p=0.014). Dose–response analysis revealed no nonlinear relationships between PAH metabolites and TH sensitivity indices in women or individuals aged 60 years and older. Weighted quantile regression analysis demonstrated that OH-PAHs exerted a statistically significant effect (p

Riduce il dolore, l’affaticamento e l’impatto globale della malattia

Objectives
Faecal immunochemical testing (FIT) is now commonplace in the UK to prioritise symptomatic patients for urgent gastrointestinal investigation. The test requires a stool sample to be collected at home by the patient and returned for analysis. In this qualitative study, we sought to understand the feasibility and acceptability of FIT-based triage for patients.

Design
A cross-sectional, qualitative, experiential interview study.

Setting
Recruitment was through three participating UK NHS sites (Yorkshire, Midlands, North-East). Health professionals were also identified through membership of the BSG/ACPGBI Symptomatic FIT Guideline Development Group and snowball sampling.

Participants
We interviewed 21 patients who had completed FIT and been referred for colonoscopy and 30 primary and secondary care health professionals involved in symptomatic FIT delivery.

Results
Completion of FIT was unproblematic from the perspective of patients who returned the test. However, health professionals expressed concern over non-return. Among patients, understanding of the purpose of FIT and the meaning of results varied. Health professionals acknowledged that ensuring patient understanding of these can be challenging. Patients believed colonoscopy was less likely to miss cancer than FIT. Patients with a family or personal history of cancer were particularly anxious and wanted the reassurance of colonoscopy, even with a negative FIT result.

Conclusions
We found no major barriers to the use of FIT in prioritising symptomatic patients for urgent investigation. Improving communication might increase compliance and, possibly, acceptability of non-referral for colonoscopy in the case of a negative test result.

Introduction
Environmental tobacco smoke (ETS) is generally known as secondhand smoke. Assessing the magnitude of children’s exposure to ETS from early infancy is essential for public health and research endeavours. Urinary cotinine is now widely recognised as the primary indicator for assessing exposure to ETS across all age groups. This systematic review and meta-analysis aim to synthesise all the published evidence on the urinary cotinine cut-off concentrations used to categorise children under 5 years as being exposed to ETS.

Methods and analysis
We will conduct a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A comprehensive search will be conducted from various databases including PubMed, EMBASE, Scopus and Cochrane Library. This search will be performed from the earliest published articles up to the latest available studies until February 2025. We will include all the experimental and observational studies, such as cohort, case–control and cross-sectional, that measure urinary cotinine concentrations in children under 5 years old. Data extraction will be conducted using a standardised data extraction form, and the study quality will be evaluated according to the guidelines specified by the Newcastle-Ottawa Scale. The extracted data will be pooled and combined for meta-analysis. Two reviewers will independently screen, select and assess the quality of the included study. The result will be tabulated in a table of characteristics of the included study, which consists of the cut-off cotinine concentrations, analytical technique, method referred, study design, study area and respondents’ characteristics.

Ethics and dissemination
Ethics approval is not required as this is a review of collected published data. Findings will be disseminated in peer-reviewed publications and conference presentations, as well as with key stakeholders, health policymakers and healthcare professionals.

PROSPERO registration number
CRD42024556969.