Search Results for: Analisi sull’uso dei farmaci anti-osteoporotici in sette database europei

Obesity remains a substantial public health challenge in the US, affecting more than 40% of US adults. There exist a range of effective weight loss treatments, including comprehensive lifestyle interventions, anti-obesity medications (AOMs), and metabolic and bariatric procedures; however, weight regain is pervasive, and the promotion of long-term weight loss maintenance persists as a key obstacle for researchers and clinicians. The conceptualization of obesity as a chronic disease has highlighted the need for continuous care to support long-term treatment outcomes. Indeed, the most successful approaches for supporting long-term weight loss maintenance have included continued treatment provision (ie, continued provision of lifestyle intervention support via extended-care programs or sustained use of AOMs) and/or more invasive surgical approaches. These approaches, however, are costly and may not be appropriate for all patients.

In Reply We appreciate the interest in our trial from Fan and Gong and Laguna and Hincapié. The ideal sham acupuncture (SA) should be inert to enable differentiation of the specific and nonspecific effects of acupuncture, yet indistinguishable from real acupuncture to allow blinding of patients. We agree that inert SA does not exist; however, SA is a critical control group for acupuncture trials. Noninvasive SA is more inert than invasive SA but has difficulty maintaining blinding in patients familiar with acupuncture. In this study, we adopted SA control combining conventional needling (invasive) at the fifth nonacupoint and blunt-tipped needle (noninvasive) at other nonacupoints. Although a needle was inserted at the fifth location in the SA group, an acupuncture effect is unlikely as this nonacupoint location is far from known acupoints and meridians. Similarly, the noninvasive SA technique was also used at nonacupoints. The clinical improvement observed in the SA group may be the result of a combination of the Hawthorne effect, regression to the mean, self-healing, tactile stimulation, physician-patient communication, and placebo effects. Future pragmatic randomized clinical trials comparing acupuncture with nonsteroidal anti-inflammatory drugs or surgery are needed to evaluate the effectiveness of acupuncture for patients with chronic sciatica from herniated discs.

In Reply We thank Swartzendruber and Lambert for their interest in our Research Letter on crisis pregnancy centers (CPCs); however, we stand by our findings. The correspondents claim that our definition of CPCs is incorrect. Yet, our definition aligns with common understanding and is remarkably similar to the one used by Swartzendruber and Lambert themselves: “nonprofit organizations with a primary aim of keeping women from having an abortion.” Additionally, we crowdsourced CPCs from lists vetted by experts, including the Fake Clinic Database (Reproaction) and Expose Fake Clinics (Access Front).

Osteoarthritis (OA) of the knee is a degenerative joint disease in which the cartilage in the knee joint wears down, causing the bone adjacent to the joint to proliferate; often, inflammation is present due to abnormal biomechanics and reactions to the debris released from the degenerating cartilage. OA is the most common joint disorder in the US with symptomatic knee OA present in 10% of men and 13% of women 60 years or older and can significantly impact mobility over time if left untreated. To date, there are no medical treatments that can slow the progression of the disease. Guidelines provided by professional societies recommend lifestyle interventions including weight loss and exercise and pharmacologic treatments including medications to treat the joint pain, nutraceuticals, and intermittent joint injections with either glucocorticoids or hyaluronic acid. Numerous clinical studies have evaluated disease-modifying therapies for OA such as potent anti-inflammatories, molecules to stimulate cartilage growth, and antiresorptive agents (eg, bisphosphonates to reduce bone remodeling). However, none have been successful in late-stage clinical trials to slow the progression of the disease.

Objectives
The inflammatory response from acute infection may trigger cardiovascular events. We aimed to estimate associations between microbiologically confirmed urinary tract infections (UTIs) and first acute myocardial infarction (MI) and stroke.

Design
We used a self-controlled case series, with risk periods 1–7, 8–14, 15–28 and 29–90 days after UTI. Included individuals experienced the outcome and exposure of interest and acted as their own controls.

Setting
We used individually linked general practice, hospital admission and microbiology data for the population of Wales held by the Secure Anonymised Information Linkage databank.

Participants
Included individuals were Welsh residents aged over 30 years with a record of a hospital admission for MI or stroke (outcomes) and evidence of a microbiologically confirmed UTI (exposure) during the study period of 1 January 2010 to 31 December 2020.

Main outcome measures
The primary outcome was acute MI or stroke identified using the International Classification of Disease V.10 codes from inpatient diagnoses recorded in the Patient Episode Database for Wales. We used Poisson regression to estimate incidence rate ratios (IRRs) and 95% CIs for MI and stroke during predefined risk periods, compared with baseline periods.

Results
During the study period, 51 660 individuals had a hospital admission for MI, of whom 2320 (4.5%) had 3900 microbiologically confirmed UTIs, and 58 150 had a hospital admission for stroke, of whom 2840 (4.9%) had 4600 microbiologically confirmed UTIs. There were 120 MIs during risk periods and 2190 during baseline periods, with an increased risk of MI for 1–7 days following UTI (IRR 2.49, 95% CI (1.65 to 3.77)). There were 200 strokes during risk periods and 2640 during baseline periods, with an increased risk of stroke for 1–7 days following UTI (IRR 2.34, 95% CI (1.61 to 3.40)).

Conclusions
UTI may be a trigger for MI or stroke. Further work is needed to understand mechanisms and test interventions to reduce the risk of cardiovascular events among people with UTIs in primary care.

Introduction
Previous studies have pointed out that persistent cough is a common complication after pulmonary resection and its occurrence is closely related to inflammatory response. However, there are no clinical studies to date that directly verify that the use of non-steroidal anti-inflammatory drugs (NSAIDs) can reduce the incidence of persistent cough after pulmonary resection (CAP). In view of this, this study aimed to explore and confirm whether exposure to NSAIDs can effectively reduce the incidence of CAP through a prospective cohort study.

Methods and analysis
We will conduct a single-centre, prospective cohort comparative study to investigate the impact of NSAIDs use on persistent cough after video-assisted thoracoscopic (VATS) lung resection surgery. The study will include all patients without preoperative cough symptoms who are scheduled for VATS lung resection. These patients will be divided into exposed and non-exposed groups according to whether they used NSAIDs after surgery. The primary outcome measures of this study are the incidence of CAP and the association between NSAIDs exposure and the incidence of CAP in patients undergoing VATS lung resection, while the secondary outcome parameter was set as severity of cough.

Ethics and dissemination
This research was approved by the Ethics Committee of the 920th Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army (2024-041-01). The study findings will be published in peer-reviewed journals and presented at professional conferences.

Trial registration number
NCT06476249.

Stroke, Ahead of Print. BACKGROUND:As indications for and utilization of mechanical thrombectomy continue to expand, there has been an increasing focus on developing improved tools for functional outcome prediction. We aim to evaluate the reliability of utilizing the areas of contrast staining for the Alberta Stroke Program Early Computed Tomography Score (s-ASPECTS) rating in immediate postthrombectomy flat-panel computed tomography and investigate its outcome predictive performance.METHODS:Retrospective analysis of a prospectively collected institutional mechanical thrombectomy database spanning March 2018 to February 2024. s-ASPECTS was calculated. We used ordinal logistic regression models to estimate the relationship between s-ASPECTS and the 90-day modified Rankin Scale and the additional value of these findings to the linear predictor of the MR-PREDICTS tool.RESULTS:One thousand sixty-three patients were included in this study with a mean age of 65±15 years, with 53% being male. s-ASPECTS was independently associated with functional outcomes. s-ASPECTS was observed to have more relevance in the clinical predictive model compared with baseline Alberta Stroke Program Early Computed Tomography Score, as well as to occlusion site and final expanded Thrombolysis in Cerebral Infarction grade. s-ASPECTS was lower among patients with more proximal occlusions, with a lower degree of final reperfusion, with a higher number of passes and longer procedures. The information gathered from flat-panel computed tomography added 18% of new information to MR-PREDICTS, as assessed by the ratio of the variances of the estimated probabilities of good functional outcome with an interobserver consensus score of κ=0.63.CONCLUSIONS:s-ASPECTS was reliably reported and found to be a stronger predictor of outcome compared with baseline Alberta Stroke Program Early Computed Tomography Score, characterizing it as an important prognostic tool for evaluating functional outcomes of patients following mechanical thrombectomy. Further studies are warranted.

La raccolta dei dati sanitari non è più solo ricavata da un esame o dal risultato di un’analisi. Ora arriva direttamente dall’interno del nostro corpo e promette una rivoluzione per…

Objectives
Low-level viremia (LLV) is a risk factor affecting the prognosis of patients with chronic hepatitis B (CHB). The objective of this study was to systematically assess the prevalence of LLV, thereby providing robust evidence-based medical insights into effective clinical interventions and preventative measures against LLV.

Design
Systematic review and meta-analysis.

Data sources
A comprehensive literature search was conducted across various databases, including China National Knowledge Infrastructure, Wanfang Data (Wanfang), China Science And Technology Journal Database (VIP-CSTJ), China Biology Medicine disc (CBMdisc), PubMed, Embase, Web of Science and the Cochrane Library, spanning from the inception of these databases up to 5 January 2024.

Eligibility criteria
The research type included either a cross-sectional study or a cohort study focusing on the Chinese population, with the outcome being LLV. The languages were limited to both Chinese and English. Studies with any of the following were excluded: subjects with other comorbidities, original articles inaccessible or data unavailable, and duplicate publications.

Data extraction and synthesis
Literature management used EndNote X9.1, and an information extraction table was created using Microsoft Excel to record research information, including first author, year of publication and study type. The prevalence of LLV was assessed via meta-analysis. Meta-analyses were conducted in RStudio using the ‘metaprop ()’ function. Subgroup analysis and sensitivity analysis were used to identify sources of heterogeneity, and funnel plots and AS-Thompson tests were employed to evaluate publication bias.

Results
18 studies, encompassing a total sample of 9773 patients, were included in the analysis. Of these, 3336 patients were identified with LLV. The meta-analysis revealed that the prevalence of LLV among treated CHB patients stands at 33.6% (95% CI 30.2 to 37.0). The antigen status, antiviral treatment regimen (type of drugs and nucleos(t)ide analogues (NAs)), treatment duration, medication adherence and baseline hepatitis B virus DNA levels all affected the prevalence of LLV. Sensitivity analysis further corroborated the stability of these meta-analysis findings. The funnel plot and AS-Thompson test indicated no significant publication bias (t = –0.01, p=0.995).

Conclusions
The prevalence of LLV among CHB patients was established at 33.7% (95% CI 29.8% to 37.6%). Thus, it is imperative for clinical decision-makers to consider the various influencing factors of LLV when formulating treatment plans in order to mitigate any potential adverse outcomes.

In this meta-analysis, patients were twice as likely to have flares during the 3 months after stopping prophylactic colchicine or NSAIDs.

Cellule cancerose modificano loro struttura per sfuggire farmaci

Importance
Background rates are critical for contextualising safety signals arising from COVID-19-related interventions in investigational or real-world settings.

Objective
To estimate background rates of medical events of interest (MEI) for which COVID-19 infection and/or COVID-19 interventions may be risk factors in two US claims databases.

Design, setting and participants
This retrospective cohort study spans the pre-COVID-19 (2018–2019) and COVID-19 (2020–2021) periods. We constructed three cohorts, in each of Inovalon/HealthVerity (Inovalon/HV) and Optum databases: a COVID-19-positive adult cohort (2020–2021), a paediatric cohort (2018–2021) and a high-risk cohort (2018–2021) comprising patients at increased risk for severe COVID-19. Participants were indexed on the day they first qualified to enter each cohort during the study period. Background rates of 17 MEI were estimated per 1000 person-years (PY) with 95% CIs.

Main outcomes and measures
Annual incidence rates (IRs) of 17 MEI.

Results
Overall, 758 414 (COVID-19-positive adults; 57.8% women), 12 513 664 (high-risk adults; 56.8% women) and 8 510 627 (paediatric patients; 49.1% women) patients were identified in the HV database. IRs of MEI varied substantially by year, data source, study cohort and duration of follow-up. The IRs of MEI were highest among COVID-19-positive adults and lowest among paediatric patients. For example, IR of myocarditis/pericarditis per 1000 PY was 3.0 (95% CI: 2.6 to 3.4) in the COVID-19-positive adult cohort vs 0.36 (95% CI: 0.34 to 0.37) among high-risk adults and 0.05 (95% CI: 0.05 to 0.06) among paediatric patients. In the COVID-19-positive adult cohort, we observed higher IRs during 90-day follow-up (eg, IR of acute myocardial infarction (AMI) 26.5 (95% CI: 25.3 to 27.7)) vs 365-day follow-up (eg, IR of AMI 20.0 (95% CI: 9.2 to 20.8)) and during 2020 compared with 2021. IRs were higher in the high-risk adult and paediatric populations during the pre-COVID-19 period than during the COVID-19 pandemic.

Conclusions
Substantial variability was observed in IRs of MEI by study cohort, year, data source and follow-up duration. When generating background rates for contextualising safety signals from COVID-19 interventions, careful consideration must be given to the indicated subpopulation of interest, COVID-19-related temporal variations and data sources.

Introduction
Non-pharmacological interventions, including musculoskeletal manipulations (MMs), have been proven effective for musculoskeletal disorders.

Objectives
To evaluate if MMs, including osteopathic manipulation and chiropractic care, are effective to improve quality of life, pain intensity and function in older adults with musculoskeletal disorders.

Design
Systematic review.

Data sources
A systematic search was conducted on MEDLINE/PubMed, EMBASE, Scopus, Web of Science, CINAHL, Cochrane Library, from database inception up to 2 January 2025.

Eligibility criteria
Randomised controlled trials, controlled non-randomised trials and open label trials evaluating the efficacy and safety of MM such as osteopathic manipulation, chiropractic manipulation, myofascial release, craniosacral therapy, as monotherapy or adjunctive therapies in older people (age ≥65 years) with musculoskeletal disorders. The main outcomes included pain intensity, functionality and quality of life. Additionally, other related outcomes were considered, such as medical use duration, mood, mobility, motion, strength and endurance. Finally, we considered any adverse events.

Data extraction and synthesis
Selection and data extraction were performed independently by two authors. The effect estimates for each study were performed using Review Manager V.5.14. Continuous outcomes were analysed using the mean difference (95% CI). The methodological quality of the included studies was assessed using the Cochrane Risk of Bias tool 2 (RoB 2). No meta-analysis was performed.

Results
Five parallel randomised controlled trials were included, with a total sample size of 676 participants (41.6% women with a mean age of 77.3 years): 34 with chronic pain, 265 with neck pain and 377 with low back pain. MMs were not effective in patients with chronic pain, neither in pain intensity nor in functionality. For neck pain, considering the main outcomes, only in one of the two studies was there a statistically significant improvement in neck pain intensity only at week 12 for spinal manipulative treatment (SMT)+home exercise (HE) compared with HE alone (ES=–0.90 (95% CI –1.46 to –0.34); p=0.002). For low back pain, SMT+HE showed a statistically significant reduction in pain at 12 weeks compared with HE (ES=–0.79 (95% CI –1.39 to –0.19) p=0.010. For neck pain and low back pain, no statistically significant improvement in functional status and quality of life was observed with MM compared with any control group. RoB 2 showed a high risk of bias in three studies and some concerns in the others. At the domain level, the lowest risk was observed in the randomisation process (80% with some concerns). All five studies reported adverse events, none of which were serious.

Conclusions
This review provides limited and inconclusive evidence about MM to improve quality of life, pain management and functional status in older adults with musculoskeletal disorders. However, MM appears to be generally safe and well-tolerated.

PROSPERO registration number
CRD42023473203.