scholarly journals Evaluation of Pancreatotropic and Joint Efficiency of Intracellular Systemic Enzyme in Osteoarthritis

2021 ◽  
pp. 66-69
Author(s):  
Liliia Babynets ◽  
Iryna Halabitska
Keyword(s):  
Objective Assessment ◽  
Pancreatic Insufficiency ◽  
Study Groups ◽  
Exocrine Pancreatic Insufficiency ◽  
Evidence Based ◽  
Unresolved Issue ◽  
Orthopedic Surgeons ◽  
European League Against Rheumatism ◽  
Based Medicine ◽  
European League

Despite the advances of modern evidence-based medicine, the treatment of osteoarthritis (OA) remains a complex and unresolved issue. Of course, modification of the patient’s lifestyle improves the condition of a patient with osteoarthritis, but the management of a patient with osteoarthritis without drug therapy, which is mostly symptomatic, is almost impossible. The objective: was to investigate the effectiveness of intracellular systemic enzyme in the complex therapy of patients with primary OA in comorbidity with exocrine pancreatic insufficiency for the correction of pathological processes developing in patients. Materials and methods. 69 patients with primary OA in comorbidity with exocrine pancreatic insufficiency were examined. The diagnosis of OA was established on the basis of diagnostic criteria of the American College of Rheumatologists (ACR, 2018), the European Association of Rheumatologists (European League Against Rheumatism, EULAR, 2018). American Academy of Orthopedic Surgeons (AAOS, 2018), International Society for the Study of OA (OARSI, 2019). Examination of the joints included examination, palpation, and objective assessment of pain. OA symptoms were also assessed by Leken index and the Harris test. To assess the state of exocrine pancreatic insufficiency, the content of fecal α-elastase was determined and the coprogram was evaluated. Patients were divided into two groups: the 1st group received treatment of primary OA according to international recommendations, the 2nd group additionally received an enzymatic drug. Results. After the treatment, patients of the 1st group showed a statistically significant tendency to deterioration of fecal α-elastase and coprogram (p<0,05), in the 2nd group there was a statistically significant improvement of these indicators (p<0,05). There was also a statistically significant improvement in the course of primary OA in both study groups (p<0,05), but in the 2nd group the therapeutic effect was statistically significantly more significant (p<0,05). Conclusions. There was a statistically significant positive dynamics of exocrine pancreatic insufficiency and course of primary OA in the 2nd group compared to those in the 1st after treatment (p<0,05), which indicates the feasibility of using the enzyme drug in the treatment of patients with primary OA in comorbidity with exocrine pancreatic insufficiency.

scholarly journals Ergebnisse der systematischen Literatursuche als Grundlage für die „evidenzbasierten Therapieempfehlungen für FMF-Patienten mit unzureichendem Ansprechen bzw. Unverträglichkeit auf Kolchizin“ der Gesellschaft für Kinder- und Jugendrheumatologie und der Deutschen Gesellschaft für Rheumatologie

2020 ◽  
Vol 79 (9) ◽  
pp. 943-951
Author(s):  
T. Sahr ◽  
U. Kiltz ◽  
C. Weseloh ◽  
T. Kallinich ◽  
J. Braun
Keyword(s):  
Evidence Based Medicine ◽  
Deutsche Gesellschaft ◽  
Evidence Based ◽  
Kontrollierte Studien ◽  
European League Against Rheumatism ◽  
Sind Eine ◽  
Based Medicine ◽  
European League

Zusammenfassung Hintergrund Das familiäre Mittelmeerfieber (FMF) ist eine in Deutschland eher seltene genetisch bedingte Erkrankung des Kindes- und Erwachsenenalters, die durch rezidivierende Fieberschübe sowie Peritonitis, Pleuritis und Arthritis charakterisiert ist. Die etablierte Therapie mit Kolchizin ist für die meisten Patienten wirksam und verträglich. Einige Patienten sprechen aber auf diese Therapie nicht ausreichend an bzw. vertragen diese nicht. Für diese Patienten kommen Biologika in Betracht. Die Gesellschaft für Kinder- und Jugendrheumatologie (GKJR) und die Deutsche Gesellschaft für Rheumatologie (DGRh) sind übereingekommen, gemeinsame Empfehlungen für diese spezielle klinische Situation zu entwickeln. Ziel Durchführung einer systematischen Literaturrecherche (SLR) auf Basis der 2016 publizierten EULAR(European League Against Rheumatism)-Empfehlungen als Grundlage für die Entwicklung von evidenzbasierten Therapieempfehlungen für FMF-Patienten mit unzureichendem Ansprechen bzw. Unverträglichkeit auf Kolchizin. Methoden Die SLR wurde mit Referenzen aus verschiedenen Datenbanken und als Aktualisierung der bis zum Jahr 2014 durchgeführten SLR der EULAR durchgeführt, wobei die Artikel zwischen dem 01.01.2015 und dem 31.12.2017 publiziert worden sein mussten. Für die Vorselektion wurde das Abstractwerkzeug Rayyan und für die Erstellung der Evidenztabellen die Klassifikation des Oxford Centre for Evidence Based Medicine 2009 benutzt. Ergebnisse Die Suche ergab 360, nach Dublettenabgleich noch 263 Treffer. Insgesamt 88 Publikationen wurden ein- (34%) und 102 ausgeschlossen (39%), bei weiteren 73 war eine Sichtung der Vollpublikation notwendig (28%), und 43 wurden intensiver diskutiert. Schlussendlich blieben 64 Publikationen (24%) übrig. Insgesamt wurden 4 Fall-Kontroll-Studien, 31 Kohortenstudien, 8 Fallserien, 7 kontrollierte Studien (davon 5 Abstracts), 10 Übersichtsarbeiten sowie 4 Metaanalysen und systematische Reviews akzeptiert. Diskussion Die SLR wurde wissenschaftlich exakt, transparent und nach internationalen Standards durchgeführt. Die SLR erwies sich als gute Grundlage für die Konsentierung der 5 übergeordneten Prinzipien und der 10 Empfehlungen, sodass die gemeinsame Aktivität von GKJR und DGRh erfolgreich und sogar zeitnah abgeschlossen werden konnte. Die Empfehlungen sind eine solide Basis, Patienten jeden Alters mit FMF gut zu behandeln. Dabei spielen die Erklärungen zum Problem der Kolchizinresistenz eine wichtige Rolle.

Evidence-Based Medicine for Orthopedic Surgeons

2010 ◽  
Vol 18 (01) ◽  
pp. 57-63 ◽  
Author(s):  
John Kuhn ◽  
Warren Dunn ◽  
Kurt Spindler
Keyword(s):  
Evidence Based Medicine ◽  
Evidence Based ◽  
Orthopedic Surgeons ◽  
Based Medicine

scholarly journals Pancreatology: debunked myths

2020 ◽  
Vol 48 (3) ◽  
pp. 44-53
Author(s):  
N. B. Gubergrits ◽  
N. V. Byelyayeva
Keyword(s):  
Chronic Pancreatitis ◽  
Replacement Therapy ◽  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Insufficiency ◽  
Overweight And Obesity ◽  
Evidence Based ◽  
Enzyme Preparations ◽  
Enzyme Replacement ◽  
European Guidelines ◽  
Relieve Pain

Enzyme replacement therapy is not always effective enough upon exocrine pancreatic insufficiency. One of the main reasons is myths — doctors’ misconceptions about the indications and rules of replacement therapy. In particular, there is an outdated opinion about the effectiveness of tablet enzyme preparations used for the relief of pancreatic pain. However, a number of evidence-based studies have proved that enzyme preparations are not effective enough to relieve pain in chronic pancreatitis, and thus should not be used for this purpose. This statement is recorded in the United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis, as well as in the recommendations of the American College of Gastroenterology. In addition, tablet preparations are characterized by asynchronism of the passage of the chyme and the tablet along the digestive tract. The second myth is that drugs without an acid-resistant coat start hydrolyzing the components of the chyme in the stomach, which ensures higher efficiency as compared to Creon. But in the absence of a coat, enzymes are inactivated in the acidic environment of the stomach and cannot have any effect at all. The third myth is that enzyme preparations always cause constipation. In fact, constipation occurs in no more than 10% of cases. They are usually associated with an overdose of the drug, concomitant pathology or insufficient compliance. The fourth myth is that prescribing the doses of enzyme preparations indicated in the European Guidelines causes addiction. It is crucial to know that such doses do not exceed 10% of the pancreas’s own capacities, therefore, they cannot significantly affect these capabilities, which is also demonstrated by evidence-based studies. The fifth myth is that patients gain weight because of enzyme preparations, and they should not be prescribed upon overweight and obesity. Numerous data firmly show that pancreatic insufficiency often occurs in such cases, and enzyme preparations are required. The sixth myth is that a drug with a different composition can be produced under the usual established product name. For example, NEO is added to the name to “mask” a drug with a new composition. Doctors should carefully monitor the composition of such drugs. The seventh myth is that a minimicrospherical preparation (Creon) is as effective as microspherical preparation. However, this statement turned out to be a myth as well. Minimicrospherical preparations are proved to be significantly more effective in clinical practice. Thus, the above-mentioned myths, like many others, are based on insufficient knowledge in the field of pancreatology.

Evidence-based Guidelines for the Management of Exocrine Pancreatic Insufficiency After Pancreatic Surgery

2016 ◽  
Vol 264 (6) ◽  
pp. 949-958 ◽  
Author(s):  
Luis Sabater ◽  
Fabio Ausania ◽  
Olaf J. Bakker ◽  
Jaume Boadas ◽  
J. Enrique Domínguez-Muñoz ◽  
...  
Keyword(s):  
Pancreatic Surgery ◽  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Insufficiency ◽  
Evidence Based ◽  
Evidence Based Guidelines

scholarly journals Evidence-based pancreatology 2017/2018 (review of the results of studies on chronic pancreatitis and exocrine pancreatic insufficiency

2018 ◽  
Vol 40 (2) ◽  
pp. 12-20
Author(s):  
N. B. Gubergrits ◽  
N. V. Byelyayeva ◽  
G. M. Lukashevish ◽  
E. V. Berezhnaya
Keyword(s):  
Pancreatic Cancer ◽  
Cystic Fibrosis ◽  
Chronic Pancreatitis ◽  
Imaging Techniques ◽  
Pancreatic Insufficiency ◽  
Exocrine Pancreatic Insufficiency ◽  
Diagnosis And Treatment ◽  
Evidence Based

The article provides an overview of the European recommendations on the diagnosis and treatment of chronic pancreatitis. The results of evidence-based research related to the epidemiology, course of chronic pancreatitis, assessment of the informative value of various imaging techniques, reatment of pancreatic insufficiency upon chronic pancreatitis, cystic fibrosis, pancreatic cancer are analyzed. A conclusion is drawn about the need for further carrying out of evidence-based studies.

scholarly journals Catalogue of bias: attrition bias

2018 ◽  
Vol 23 (1) ◽  
pp. 21-22 ◽  
Author(s):  
David Nunan ◽  
Jeffrey Aronson ◽  
Clare Bankhead
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Study Groups ◽  
Evidence Based ◽  
Sampling Weights ◽  
Attrition Bias ◽  
Potential Impact ◽  
Based Medicine ◽  
Upper Gastrointestinal ◽  
Unclear Risk

This article is part of a series of articles featuring the Catalogue of Bias introduced in this volume of BMJ Evidence-Based Medicine that describes attrition bias and outlines its potential impact on research studies and the preventive steps to minimise its risk. Attrition bias is a type of selection bias due to systematic differences between study groups in the number and the way participants are lost from a study. Differences between people who leave a study and those who continue, particularly between study groups, can be the reason for any observed effect and not the intervention itself. Associations for mortality in trials of tranexamic acid and upper gastrointestinal bleeding were no longer apparent after studies with high or unclear risk of attrition bias were removed. Over-recruitment can help prevent important attrition bias. Sampling weights and tailored replenishment samples can help to compensate for the effects of attrition bias when present.

Gout and Hyperuricemia: New Guidelines and Treatments

2008 ◽  
Vol 22 (1) ◽  
pp. 104-115
Author(s):  
Geoffrey C. Wall ◽  
Sarah A. Cooper
Keyword(s):  
Inflammatory Arthritis ◽  
Evidence Based ◽  
Randomized Controlled ◽  
Randomized Controlled Studies ◽  
European League Against Rheumatism ◽  
Acute Attacks ◽  
New Guidelines ◽  
Evidence Based Guidelines ◽  
New Compounds ◽  
European League

Gout is the most common inflammatory arthritis in western countries and the incidence is increasing. Additionally, evidence now exists that cases of severe, refractory gout seem to be increasing. The management of gout and hyperuricemia has remained largely unchanged for decades and includes antiinflammatories used initially for acute attacks and primarily allopurinol to prevent future attacks. Evidence-based guidance for the management of gout and hyperuricemia has been plagued by a lack of randomized, controlled studies and the lack of new medications. Recently evidence-based guidelines by the European League Against Rheumatism were published; one of the first attempts by a major medical body to assess the state of gout and hyperuricemia treatment. Additionally, several new compounds seem poised to be released for hyperuricemia treatment. This review details the important aspects of the gout guidelines relating to pharmacotherapy and critically examines the data surrounding new modalities to decrease serum uric acid.

scholarly journals Keeping up with Best Evidence: What Resources are Available?

2012 ◽  
Vol 46 (1) ◽  
pp. 4-7 ◽  
Author(s):  
Nasir Hussain ◽  
Mohit Bhandari ◽  
Sarah Turvey
Keyword(s):  
Evidence Based Medicine ◽  
Healthcare Professionals ◽  
Point Of Care ◽  
Scientific Evidence ◽  
Evidence Based ◽  
Medical Journals ◽  
Orthopedic Surgeons ◽  
Allied Healthcare ◽  
Based Medicine ◽  
Quality Evidence

ABSTRACT Evidence-based medicine (EBM) teaches physicians to base their decisions and actions on the best available scientific evidence in conjunction with their own expertise and the patient's values and preferences; however, this can be very time consuming as a one has to stay current and up-to-date with the most recent evidence. Several point-of-care databases, such as Up To Date and Dynamed, have been developed that distill the contents of medical journals into summaries with guidelines for practice in order to aid in EBM approach, but these also come with various limitations. Due to this, tools specific to surgical specialties are now beginning to be developed that systematically collect, appraise and summarize top quality evidence. One such tool is Ortho Evidence, which is an openaccess tool for orthopedic surgeons, researchers and allied healthcare professionals. How to cite this article Hussain N, Turvey S, Bhandari M. Keeping up with Best Evidence: What Resources are Available? J Postgrad Med Edu Res 2012;46(1):4-7.

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