scholarly journals Pathogenesis and prevention strategies for equine tendinopathy

2019 ◽  
Vol 37 (3) ◽  
pp. 18-19
Author(s):  
Roger K.W. Smith
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Flexor Tendon ◽  
High Impact ◽  
Prevention Strategies ◽  
Suspensory Ligament ◽  
High Risk Factors ◽  
Superficial Digital Flexor Tendon ◽  
External Trauma

Equine tendinopathy arises through two main mechanisms – external trauma or overstrain injury. The pathogenesis of the former is straight forward and prevention relies on avoiding risk factors for palmar/plantar lacerations and protecting the tendons through the use of boots. For over-strain injuries, these mostly arise from overloading of the distal limb resulting in mid-substance tearing of the digital flexor tendons or borders tears of the deep digital flexor tendon within the confines of the digital sheath and navicular bursa. While some of these injuries may be spontaneous injuries associated solely with overload (such as the intra-thecal injuries of the deep digital flexor tendon), it is widely accepted that most overstrain injuries of the superficial digital flexor tendon (and suspensory ligament) occur as a result of accumulated microdamage which predisposes the tendon to over-strain injury. The mechanisms of this accumulated microdamage are poorly understood but probably relate to the effect of high impact loading of the tendon, sustained during normal exercise, which drives degradative changes in the tendon fascicles (Dudhia et al. 2007) and, in particular, the interfascicular matrix (endotenon) that allows the fascicles to slide past one another as a mechanism for the spring-like extension of the tendon under load (Thorpe et al. 2013). This is compounded by the lack of adaptive remodelling in adult tendon (Smith et al. 2002). This subclinical damage makes the tendon prone to sudden tearing of the tendon matrix during normal exercise, the risk of which is increased by factors such as the firmness of the ground, weight, speed, and fatigue. Strategies for prevention of injury rely on identifying at risk individuals through more sensitive monitoring of tendon health, maximising the quality of tendon during growth using carefully tailored ‘conditioning’ exercise regimes (Smith & Goodship 2008), reducing the degeneration induced by normal training and competition, and avoiding high risk factors for the initiation of the clinical injury.

Relapse Prevention

2019 ◽  
pp. 127-134
Author(s):  
Dennis C. Daley ◽  
Antoine Douaihy
Keyword(s):  
Risk Factors ◽  
Substance Use ◽  
High Risk ◽  
Relapse Prevention ◽  
Warning Signs ◽  
Prevention Strategies ◽  
High Risk Factors ◽  
Initial Episode ◽  
The Difference ◽  
A Chain

A lapse refers to an initial episode of substance use following a period of abstinence. A lapse may or may not lead to more substance use. Clients always run the risk that a lapse will turn into a relapse, in which they continue to use alcohol or other drugs. A lapse or relapse is the last link in a chain of decisions, and how one responds to an initial lapse has a big impact on whether or not one has a full-blown relapse. The goals of this chapter are to understand the difference between lapse and relapse, to learn about relapse prevention strategies, and to learn to identify and manage relapse warning signs and high-risk factors.

scholarly journals Hydroxycarbamide Plus Aspirin Versus Aspirin Alone in Patients With Essential Thrombocythemia Age 40 to 59 Years Without High-Risk Features

2018 ◽  
Vol 36 (34) ◽  
pp. 3361-3369 ◽  
Author(s):  
Anna L. Godfrey ◽  
Peter J. Campbell ◽  
Cathy MacLean ◽  
Georgina Buck ◽  
Julia Cook ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Platelet Count ◽  
High Risk ◽  
Vascular Events ◽  
End Point ◽  
High Risk Factors ◽  
Patient Reported

Purpose Cytoreductive therapy is beneficial in patients with essential thrombocythemia (ET) at high risk of thrombosis. However, its value in those lacking high-risk features remains unknown. This open-label, randomized trial compared hydroxycarbamide plus aspirin with aspirin alone in patients with ET age 40 to 59 years and without high-risk factors or extreme thrombocytosis. Patients and Methods Patients were age 40 to 59 years and lacked a history of ischemia, thrombosis, embolism, hemorrhage, extreme thrombocytosis (platelet count ≥ 1,500 × 109/L), hypertension, or diabetes requiring therapy. In all, 382 patients were randomly assigned 1:1 to hydroxycarbamide plus aspirin or aspirin alone. The composite primary end point was time to arterial or venous thrombosis, serious hemorrhage, or death from vascular causes. Secondary end points were time to first arterial or venous thrombosis, first serious hemorrhage, death, incidence of transformation, and patient-reported quality of life. Results After a median follow-up of 73 months and a total follow-up of 2,373 patient-years, there was no significant difference between the arms in the likelihood of patients reaching the primary end point (hazard ratio, 0.98; 95% CI, 0.42 to 2.25; P = 1.0). The incidence of significant vascular events was low, at 0.93 per 100 patient-years (95% CI, 0.61 to 1.41). There were also no differences in overall survival; in the composite end point of transformation to myelofibrosis, acute myeloid leukemia, or myelodysplasia; in adverse events; or in patient-reported quality of life. Conclusion In patients with ET age 40 to 59 years and lacking high-risk factors for thrombosis or extreme thrombocytosis, preemptive addition of hydroxycarbamide to aspirin did not reduce vascular events, myelofibrotic transformation, or leukemic transformation. Patients age 40 to 59 years without other clinical indications for treatment (such as previous thrombosis or hemorrhage) who have a platelet count < 1,500 × 109/L should not receive cytoreductive therapy.

scholarly journals Clinical profiles and quality of care of subjects with type 2 diabetes according to their cardiovascular risk: an observational, retrospective study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Basilio Pintaudi ◽  
Alessia Scatena ◽  
Gabriella Piscitelli ◽  
Vera Frison ◽  
Salvatore Corrao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Quality Of Care ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Cardiovascular Risk Factors ◽  
High Cardiovascular Risk ◽  
Very High

Abstract Background The European Society of Cardiology (ESC) recently defined cardiovascular risk classes for subjects with diabetes. Aim of this study was to explore the distribution of subjects with type 2 diabetes (T2D) by cardiovascular risk groups according to the ESC classification and to describe the quality indicators of care, with particular regard to cardiovascular risk factors. Methods The study is based on data extracted from electronic medical records of patients treated at the 258 Italian diabetes centers participating in the AMD Annals initiative. Patients with T2D were stratified by cardiovascular risk. General descriptive indicators, measures of intermediate outcomes, intensity/appropriateness of pharmacological treatment for diabetes and cardiovascular risk factors, presence of other complications and overall quality of care were evaluated. Results Overall, 473,740 subjects with type 2 diabetes (78.5% at very high cardiovascular risk, 20.9% at high risk and 0.6% at moderate risk) were evaluated. Among people with T2D at very high risk: 26.4% had retinopathy, 39.5% had albuminuria, 18.7% had a previous major cardiovascular event, 39.0% had organ damage, 89.1% had three or more risk factors. The use of DPP4-i markedly increased as cardiovascular risk increased. The prescription of secretagogues also increased and that of GLP1-RAs tended to increase. The use of SGLT2-i was still limited, and only slightly higher in subjects with very high cardiovascular risk. The overall quality of care, as summarized by the Q score, tended to be lower as the level of cardiovascular risk increased. Conclusions A large proportion of subjects with T2D is at high or very high risk. Glucose-lowering drug therapies seem not to be adequately used with respect to their potential advantages in terms of cardiovascular risk reduction. Several actions are necessary to improve the quality of care.

Association between maternal high-risk factors and anemia among women in Ethiopia

Nutrition ◽  
2021 ◽  
pp. 111404
Author(s):  
Noha Fadl ◽  
Gillian H Ice ◽  
Zelalem T Haile
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
High Risk Factors
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