Eletroterapia em úlceras venosas: uma revisão integrativa

2019 ◽  
Vol 77 (15) ◽  
Author(s):  
Isabelle Andrade Silveira ◽  
Beatriz Guitton Renaud Baptista de Oliveira ◽  
Magali Rezende de Carvalho ◽  
Nelson Carvalho Andrade ◽  
Bruno Utzeri Peixoto
Keyword(s):  
Electrical Stimulation ◽  
Medical Center ◽  
Scientific Evidence ◽  
Wave Form ◽  
Electrical Stimulation Therapy ◽  
Level Of Evidence ◽  
Venous Ulcers ◽  
Grade Of Recommendation ◽  
Standard Wave ◽  
De Medicina

Objetivos: Descrever e analisar as evidências científicas encontradas na literatura sobre o uso da eletroterapiano reparo tecidual de úlceras venosas. Método: Revisão integrativa nas bases de dados: LILACS e MEDLINE viaPUBMED, utilizando os descritores: terapia por estimulação elétrica, úlceras venosas e cicatrização. Após a seleção,foi realizada leitura analítica, destacando: ano, título, local, autor, objetivos, método e resultados. A qualidade dosestudos foi avaliada de acordo com o Centro de Medicina Baseada em Evidências Oxford quanto ao nível de evidênciae grau de recomendação. Para análise, optou-se pela categorização temática. Resultados: Existem diferentes tiposde eletroterapias, porém não existe um padrão ouro de forma de onda e frequência de estimulação que seja omais efetivo; os estudos incluídos apresentaram resultados benéficos do uso da eletroterapia, bem como eficáciana redução do quadro álgico dos indivíduos com poucas semanas de intervenção. Conclusões: A eletroterapiaapresenta bons resultados na cicatrização de úlceras venosas, porém ainda existem lacunas importantes queprecisam ser preenchidas sobre seu uso, gerando uma demanda por estudos clínicos controlados para melhorverificar sua efetividade.Palavras-chave: Terapia por estimulação elétrica; Úlceras venosas; Cicatrização. ABSTRACTObjectives: To describe and analyze the scientific evidence in the literature on the use of electrotherapy fortissue repair venous ulcers. Method: Integrative review in databases: LILACS and MEDLINE via PubMed, using thekeywords: electrical stimulation therapy, venous ulcers and healing. After selecting analytical reading was held,highlighting: year, title, location, author, objectives, methods and results. Study quality was assessed accordingto the Medical Center Evidence-based Oxford as level of evidence and grade of recommendation. For analysisopted up the thematic categorization. Results: There are different types of electrotherapies, but there is nogold standard wave form and stimulation frequency that is the most effective; the included studies showedbeneficial results of the use of electrotherapy and efficacy in the pain reduction of individuals with few weeksof intervention. Conclusions: Electrotherapy gives good results in the healing of venous ulcers, but there are stillimportant gaps that need to be filled on its use, generating a demand for controlled clinical studies to furtherverify its effectiveness.Keywords: Electrical stimulation therapy; Venous ulcers; Healing.

Características y especialización de la respuesta inmunitaria en la COVID-19 y posibles tratamientos profilácticos

2020 ◽  
Vol 63 (4) ◽  
pp. 7-18 ◽  
Author(s):  
Anamary Súarez Reyes ◽  
Carlos Agustín Villegas Valverde
Keyword(s):  
Immune Response ◽  
Rna Virus ◽  
Scientific Evidence ◽  
World Health ◽  
Alveolar Level ◽  
Inflammatory Drugs ◽  
Interferon System ◽  
Severity Of The Disease ◽  
Health Organization ◽  
De Medicina

Characteristics and Specialization of the Immune Response in COVID-19 Abstract The outbreak of coronavirus pneumonia in Wuhan, China, became a pandemic on March 11, 2020. It has caused almost 4 million confirmed cases worldwide, with more than 270,000 deaths. Coronavirus is an enveloped RNA virus of the β-coronavirus genus distributed in birds, humans, and other mammals. The World Health Organization has named the new disease COVID-19. The scientific community is look http://doi.org/10.22201/fm.24484865e.2020.63.4.02 8 8 Revista de la Facultad de Medicina de la UNAM | ing for evidence that can lead to a better understanding of the infection and the immune response (IR), prognostic and therapeutic predictors, effective treatments and vaccines. The objective of this review was to compile updated scientific evidence of the IR to COVID-19, in order to guide professionals with solutions that have a clinical impact. The most important elements involve innate immunity with failures in the interferon system in the early stages of the infection and a sustained increase in proinflammatory interleukins. This can end in a potentially fatal cytokine storm. The infiltration of neutrophils and macrophages at the alveolar level, accompanied by neutrophilia, is very characteristic. Lymphopenia is evident at the adaptive immunity level, that, depending on the degree, can indicate the severity of the disease. Understanding the temporal sequence of the IR is crucial for choosing the appropriate and effective therapies, especially when selecting which type of anti-inflammatory drugs can be used and the frequency of the dosage. Due to the fact that it is difficult to determine when they will be clearly beneficial, not harmful to the IR and not too late, due to the irreversibility of the process. Key words: COVID-19; coronavirus; immune response

scholarly journals Deferring Routine Wrist Radiography Does Not Affect Management of de Quervain Tendinopathy Patients

2017 ◽  
Vol 07 (02) ◽  
pp. 115-120 ◽  
Author(s):  
Tiffany Liu ◽  
Chia Wu ◽  
David Steinberg ◽  
David Bozentka ◽  
L. Levin ◽  
...  
Keyword(s):  
Physical Examination ◽  
Medical Center ◽  
Academic Medical Center ◽  
Diagnostic Study ◽  
Level Of Evidence ◽  
Radiographic Findings ◽  
Academic Medical ◽  
De Quervain ◽  
Clinical Records ◽  
Surgical Release

Background Obtaining wrist radiographs prior to surgeon evaluation may be wasteful for patients ultimately diagnosed with de Quervain tendinopathy (DQT). Questions/Purpose Our primary question was whether radiographs directly influence treatment of patients presenting with DQT. A secondary question was whether radiographs influence the frequency of injection and surgical release between cohorts with and without radiographs evaluated within the same practice. Patients and Methods Patients diagnosed with DQT by fellowship-trained hand surgeons at an urban academic medical center were identified retrospectively. Basic demographics and radiographic findings were tabulated. Clinical records were studied to determine whether radiographic findings corroborated history or physical examination findings, and whether management was directly influenced by radiographic findings. Frequencies of treatment with injection and surgery were separately tabulated and compared between cohorts with and without radiographs. Results We included 181 patients (189 wrists), with no differences in demographics between the 58% (110 wrists) with and 42% (79 wrists) without radiographs. Fifty (45%) of imaged wrists demonstrated one or more abnormalities; however, even for the 13 (12%) with corroborating history and physical examination findings, wrist radiography did not directly influence a change in management for any patient in this series. No difference was observed in rates of injection or surgical release either upon initial presentation, or at most recent documented follow-up, between those with and without radiographs. No differences in frequency, types, or total number of additional simultaneous surgical procedures were observed for those treated surgically. Conclusion Wrist radiography does not influence management of patients presenting DQT. Level of Evidence This is a level III, diagnostic study.

scholarly journals Percutaneous versus Transcutaneous Electrical Stimulation of the Posterior Tibial Nerve in Idiopathic Overactive Bladder Syndrome with Urinary Incontinence in Adults: A Systematic Review

Healthcare ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 879
Author(s):  
Aida Agost-González ◽  
Isabel Escobio-Prieto ◽  
Azahara M. Pareja-Leal ◽  
María Jesús Casuso-Holgado ◽  
María Blanco-Diaz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Urinary Incontinence ◽  
Electrical Stimulation ◽  
Overactive Bladder ◽  
Tibial Nerve ◽  
Scientific Evidence ◽  
Transcutaneous Electrical Stimulation ◽  
Posterior Tibial Nerve ◽  
Posterior Tibial

Background: Percutaneous electrical stimulation and transcutaneous electrical stimulation (PTNS and TTNS) of the posterior tibial nerve are internationally recognized treatment methods that offer advantages in terms of treating patients with overactive bladder (OAB) who present with urinary incontinence (UI). This article aims to analyze the scientific evidence for the treatment of OAB with UI in adults using PTNS versus TTNS procedures in the posterior tibial nerve. Methods: A systematic review was conducted, between February and May 2021 in the Web of Science and Scopus databases, in accordance with the PRISMA recommendations. Results: The research identified 259 studies, 130 of which were selected and analyzed, with only 19 used according to the inclusion requirements established. The greatest effectiveness, in reducing UI and in other parameters of daily voiding and quality of life, was obtained by combining both techniques with other treatments, pharmacological treatments, or exercise. Conclusions: TTNS has advantages over PTNS as it is more comfortable for the patient even though there is equality of both therapies in the outcome variables. More research studies are necessary in order to obtain clear scientific evidence.

Evaluation of Cost-effectiveness and Clinical Value of Routine Histopathologic Examination of Septoplasty Specimens

2021 ◽  
pp. 019459982110129
Author(s):  
Randall S. Ruffner ◽  
Jessica W. Scordino
Keyword(s):  
Chart Review ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Clinical Value ◽  
Level Of Evidence ◽  
Significant Pathology ◽  
National Model ◽  
Routine Histopathologic Examination

Objectives During septoplasty, normal cartilage and bone are often sent for pathologic examination despite benign appearance. We explored pathology results following septoplasty from April 2016 to April 2018, examining clinical value and relevance, implications, and cost analysis. Study Design Retrospective chart review. Setting Single-institution academic medical center. Methods A retrospective chart review was compiled by using Current Procedural Terminology code 30520 for septoplasty for indication of nasal obstruction, deviated septum, and nasal deformity. Results A total of 236 consecutive cases were identified spanning a 2-year period. Septoplasty specimens were sent for pathology evaluation in 76 (31%). The decision to send a specimen for histopathology was largely physician dependent. No cases yielded unexpected or significant pathology that changed management. The average total charges for septoplasty were $10,200 at our institution, with 2.2% of procedural charges accounting for pathology preparation and review, averaging $225. Nationally, this results in an estimated charged cost of $58.5 million. The Centers for Medicare and Medicaid Services (CMS) reimbursement for septoplasty pathology charges was $46 in 2018, accounting for 1.3% of hospital-based reimbursements and 2.2% of ambulatory center reimbursements. With CMS as a national model for reimbursement, $11.8 million is spent yearly for septoplasty histopathology. Given that CMS reimbursement is significantly lower than private insurers, national total reimbursement is likely considerably higher. Conclusion Routine pathology review of routine septoplasty specimens is unnecessary, unremarkable, and wasteful. Correlation of the patient’s presentation and intraoperative findings should justify the need for pathology evaluation. This value-based approach can offer significant direct and indirect cost savings. Level of evidence 4.

scholarly journals Oral care and nosocomial pneumonia: a systematic review

2015 ◽  
Vol 13 (2) ◽  
pp. 290-296 ◽  
Author(s):  
Maria Carolina Nunes Vilela ◽  
Gustavo Zanna Ferreira ◽  
Paulo Sérgio da Silva Santos ◽  
Nathalie Pepe Medeiros de Rezende
Keyword(s):  
Systematic Review ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Nosocomial Pneumonia ◽  
Oral Hygiene ◽  
Oral Care ◽  
Control Group ◽  
Level Of Evidence ◽  
Grade Of Recommendation ◽  
Minimal Bias

To perform a systematic review of the literature on the control of oral biofilms and the incidence of nosocomial pneumonia, in addition to assessing and classifying studies as to the grade of recommendation and level of evidence. The review was based on PubMed, LILACS, and Scopus databases, from January 1st, 2000 until December 31st, 2012. Studies evaluating oral hygiene care related to nosocomial infections in patients hospitalized in intensive care units were selected according to the inclusion criteria. Full published articles available in English, Spanish, or Portuguese, which approached chemical or mechanical oral hygiene techniques in preventing pneumonia, interventions performed, and their results were included. After analysis, the articles were classified according to level of evidence and grade of recommendation according to the criteria of the Oxford Centre for Evidence-Based Medicine. A total of 297 abstracts were found, 14 of which were full articles that met our criteria. Most articles included a study group with chlorhexidine users and a control group with placebo users for oral hygiene in the prevention of pneumonia. All articles were classified as B in the level of evidence, and 12 articles were classified as 2B and two articles as 2C in grade of recommendation. It was observed that the control of oral biofilm reduces the incidence of nosocomial pneumonia, but the fact that most articles had an intermediate grade of recommendation makes clear the need to conduct randomized controlled trials with minimal bias to establish future guidelines for oral hygiene in intensive care units.

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