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Summary Introduction Oral lichen is a chronic inflammatory disease for which diagnostic management and follow-up are heterogeneous given the absence of specific guidelines in France. Our objective was to develop French multidisciplinary guidelines for the management of oral lichen. Materials and methods Working groups from the Groupe d’Etude de la Muqueuse Buccale (GEMUB) formulated a list of research questions and the corresponding recommendations according to the “formal consensus” method for developing practice guidelines. These recommendations were submitted to a group of experts and the degree of agreement for each recommendation was assessed by a scoring group. Results Twenty-two research questions, divided into 3 themes (nosological classification and initial assessment, induced oral lichenoid lesions, and follow-up) resulted in 22 recommendations. Initial biopsy for histology is recommended in the absence of reticulated lesions. Biopsy for direct immunofluorescence is recommended for ulcerated, erosive, bullous types and for diffuse erythematous gingivitis. Management should include a periodontal and dental check-up, and investigation for extra-oral lesions. Hepatitis C testing is recommended only if risk factors are present. Definitions, triggering factors and the management of “induced oral lichenoid lesions” were clarified. Oral lichen must be monitored by a practitioner familiar with the disease at least once a year, using objective tools. Conclusion This formalised consensus of multidisciplinary experts provides clinical practice guidelines on the management and monitoring of oral lichen.

Osteoarthritis is a rheumatic disease characterized by degeneration and decay of cartilage in the joints. As the disease worsens, the joint space narrows causing numbness and pain, which often impairs movement. In addition to pharmacological therapy, low-intensity laser (LILT), high-intensity laser (HILT) and exercise are used to treat osteoarthritis (OA) of the knee. HILT is a new modality in our country and the experience from its application is small, especially in the treatment of OA of the knee. Aim of the paper was to compare the effect of HILT with LILT in the treatment of OA of the knee. Material and methods: This was a randomized comparative unilateral blind study involving 72 patients divided into two groups. The first group was treated with HILT, the second group treated with LILT. Outcome measure was the visual analogue scale (VAS) for pain, which was made on the first and tenth day of treatment. Statistical significance was defined as p, Остеоартритисот е ревматолошко заболување кое се карактеризирасо дегенерација и распаѓање на 'рскавицата во зглобовите. Со влошување на болеста, зглобниот простор се стеснува предизвикувајќи вкочанетост и болка, што често го нарушува движењето. Освен фармаколошка терапија, во лекувањето на остеоартитисот (ОА) на коленото се применува нискоинтензивен ласер (НИЛТ), високоинтензивен ласер (ВИЛТ) и вежби. ВИЛТ е нов модалитет во нашата земја и искуството од неговата примена е мало, особено во лекувањето на ОА на коленото. Цел на трудот е да се спореди ефектот на ВИЛТ во однос на НИЛТ во лекувањето на болката кај остеоратитис на коленото. Материјал и методи: Рандомизирано, компаративно, еднострано слепо истражување во кое учествуваа 72 пациенти поделени во две групи. Првата група беше лекувана со ВИЛT, а втората група со НИЛТ. Како мерка за исход беше користена визуелно аналогна скала (ВАС) за болка, која беше направена на првиот и десеттиот ден од лекувањето. За статистичка значајност беше земено р

A case of posttraumatic stress disorder (PTSD) in the last days of life is presented. It shows insufficient pharmacological therapy and PTSD that was not recognized early enough. We discuss the dilemma caused by the necessity of a long-term psychotherapy and the challenge of little time being left at the end of life. Additionally, a language barrier can be a main reason for misinterpreting symptoms of PTSD.

Hereditarni hemoragicka teleangiektazie (HHT) je choroba s abnormalni tvorbou cev, což vede ke krvacivým komplikacim. Zmensit jejich intenzitu ci zcela jim zabranit mohou antiangiogenni leky, jako je bevacizumab, aflibercept, thalidomid, lenalidomid a dalsi ze skupiny antiangiogennich inhibitorů tyrosinkinaz. Jsou ucinne jak při systemovem, tak při lokalnim podani. Tyto nove leky přibyly ke klasicke terapii, jako je suplementace železa, antifibrinolytika a hormonalni lecba. Tento přehled se koncentruje na nove antiangioproliferativni leky ucinne u HHT, ktere mohou být dnes použity pro lecbu, ale naznacuje i ktere leky se možna po ověřeni klinickými studiemi dostanou brzy do praxe.

Knee osteoarthritis is a degenerative arthritis that mainly affects older adults. Over time, osteoarthritis can result in significant and sustained discomfort, pain, and disability. Current treatment focuses on the alleviation of pain and functional impairment. While arthroplasty is the definitive management option, it subjects patients to surgical complications, and the possibility of surgical revisions. In addition, many patients are not surgical candidates. Instead, pharmacological therapy is recommended first-line for most patients. On top of pharmacological therapy, there are a range of non-operative procedural options available. However, leading professional guidelines vary in their recommendations for these agents. Therefore, we present a review of recent randomized controlled trials and meta-analyses on injectable corticosteroids, hyaluronic acid (HA), platelet-rich plasma (PRP), mesenchymal stem cell injections, and ozone therapy. The preliminary data reveal the strongest evidence in favour of corticosteroid injections, although there are promising findings regarding the long-term efficacy of HA and PRP.

A 35-year-old man experienced respiratory agony while sleeping followed by a generalized seizure. Subsequent exclusively neurological diagnostics showed no pathological findings. Four months later, the patient suffered a sudden cardiac death due to ventricular fibrillation, which he survived without neurological deficit. After initially unremarkable diagnostics, the diagnosis could be made electrocardiographically. Following a special pharmacological therapy, the patient remained free from further episodes of ventricular fibrillation in the long-term follow-up.

Introduction: Sleep hygiene therapy is a non- pharmacological therapy that can be done by nurses in providing nursing actions to schizophrenic patients. Methods: The design of this research is Pre- Experimental Design in the form of One-Group Pretest-Postest Design. The sampling technique used purposive sampling with a total of 15 respondents Results: The results of the analysis showed that there were differences in the sleep quality of schizophrenic patients before and after sleep hygiene therapy which was indicated by the results of the Paired Sample T- Test analysis where the significance results were p value = 0.000

Gastro-oesophageal reflux (GOR) and cow’s milk protein intolerance (CMPI) are two frequently occurring conditions found in infancy. The aim of this review is to examine the association between the two. A literature review was conducted via PubMed, Sciencedirect and Google scholar using search terms “gastro-oesophageal reflux” + “cow’s milk protein intolerance”. The inclusion criteria were studies from 1985 to present, studies involving infants and studies involving both GOR and CMPI. Exclusion criteria were studies not including infants, or studies involving GOR or CMPI independently. This review revealed varying degrees of co-existence of GOR and CMPI. Iacono et al., Farahmand et al., Kamer et al., and Semeniuk and Kaczmarski, displayed co-occurrence of GOR and CMPI in 41.8%, 33.3%, 46.5%, and 44.9% of infants respectively. In two separate studies by Cavataio et al., concomitance was apparent in 41.6% and 30% of infants. Others suggested a less significant link at 16–20%. Nielsen et al. found 18/42 children to have severe GORD, 10 of whom had CMPI in addition. This review highlights an association between GOR and CMPI. CMPI should be considered, particularly in cases of reflux resistant to pharmacological therapy, as a co-existing or causative entity accounting for symptoms.

Aim In this review, several gastrointestinal diseases that dentists may encounter in practice are highlighted and discussed. Materials and methods Using MEDLINE (PubMed), a comprehensive review of gastrointestinal diseases and their oral cavity manifestations was performed. Results Many gastrointestinal diseases present with oral symptoms that are detectable by dentists and dental hygienists. Often, oral manifestations of the disease may appear before systemic signs and symptoms. Managing patients with these conditions requires dentists to adjust their treatment and/or involve other health professionals. Conclusion Care must be taken when providing periodontal therapy or dental implants to patients suffering gastrointestinal diseases who are at high risk of bleeding, infection, or malnutrition, for example. Also, pharmacological therapy for these patients may need to be customized.

Introducción: El ejercicio físico, es comúnmente utilizado como tratamiento primario o coadyuvante de terapia farmacológica, presentando resultados prometedores en la reducción del 30%-40% de padecer cáncer de seno. Objetivo: Determinar los beneficios del entrenamiento en fuerza resistencia sobre la calidad de vida en mujeres diagnosticadas con cáncer de seno, mediante una revisión sistemática de la literatura. Metodología: Revisión sistemática de la literatura acorde con los lineamientos descritos en la declaración PRISMA y el Manual Cochrane para la conducción de Revisiones Sistemáticas de Intervenciones versión 5.1.0. La búsqueda sistemática se realizó entre los años 1990 y 2018. Resultados: Todos los estudios evaluados incluyeron población con cáncer de seno y evaluaron la calidad de vida mediante diferentes protocolos. Conclusión: El entrenamiento de fuerza resistencia favorece el estado de salud, parámetros psicológicos, síntomas de dolor, funcionalidad física, funcionalidad y disfrute sexual, fatiga, estado de ánimo, salud emocional, salud cognitiva, composición corporal y capacidad física.

Most patients with mental disorders can be effectively treated with therapies such as pharmacological therapy, psychotherapy, electroconvulsive therapy. These treatments can be used individually or in combination. However, some patients either do not respond to therapy or experience severe side effects. It is for these patients that neurosurgical procedures may be considered. Psychosurgery is considered brain surgery used to alleviate painful mental manifestations or to mitigate the course of mental illness. Psychosurgery can be talked about as a way to correct mental disorders. It should be considered as a link in the system of treatment and rehabilitation of patients with therapeutically resistant mental disorders.Despite the centuries-old history of psychosurgery, the question of the expediency of using surgical methods for the treatment of mental disorders still remains one of the intractable ones. Today, psychosurgery is a low-traumatic operation, which is associated with targeted and dosed interventions on the deep parts of the human brain. This review describes the main stages in the development of psychosurgery, the main surgical methods used to treat mental disorders, and also discusses the future probable directions of neurosurgical treatment in a psychiatric clinic. The argumentation for the use of this type of treatment in the formation of manifestations of therapeutic resistance is given. Taking into account the diametrality in assessing the feasibility of using the methods of psychosurgery, the concluding part of the article discusses the pros and cons of surgical treatment of mental disorders.

Acute kidney injury (AKI) is a serious kidney disease without specific medications currently except for expensive dialysis treatment. Some potential drugs are limited due to their high hydrophobicity, poor in vivo stability, low bioavailability and possible adverse effects. Besides, kidney-targeted drugs are not common and small molecules are cleared too quickly to achieve effective drug concentrations in injured kidneys. These problems limit the development of pharmacological therapy for AKI. Nanotherapeutics based on nanotechnology have been proved to be an emerging and promising treatment strategy for AKI, which may solve the pharmacological therapy dilemma. More and more nanotherapeutics with different physicochemical properties are developed to efficiently deliver drugs, increase accumulation and control release of drugs in injury kidneys and also directly as effective antioxidants. Here, we discuss the recent nanotherapeutics applied in the treatment and prevention of AKI with improved effectiveness and few side effects., Graphical abstract Image, graphical abstract

Pendahuluan: Prevalensi Diabetes Melitus (DM) di Indonesia tinggi dan bahkan mengalami fluktuasi dari 422 juta jiwa menjadi 463 juta jiwa dalam 5 tahun. Pada tatalaksana penyakit DM, salah satunya ialah terapi farmakologi menggunakan Obat Antihiperglikemik (OAH). Saat ini selain OAH, masyarakat juga menggunakan herbal untuk mengatasi DM. Senyawa aktif herbal yang telah terbukti berkontribusi dalam pengobatan beragam dan multikomponen, namun tidak semua komponen tersebut diketahui memberikan efek terapeutik pada DM. Maka, tujuan dari tinjauan pustaka ini untuk mengetahui interaksi yang terjadi antara obat konvensional dan herbal untuk DM. Metode: Pencarian literatur dilakukan pada bulan Mei 2020. Situs yang digunakan adalah Google Scholar, Elsevier dan NCBI. Kata kunci yang digunakan untuk menemukan sumber jurnal ialah “interaksi obat DM dan herbal”, “interaction of diabetic drugs and herbs”, “herbal untuk diabetes”, dan “herbs for diabetes”. Jurnal yang digunakan sebagai sumber berjumlah 15 jurnal dengan fokus penelitian secara in vivo dan klinis. Hasil: Multikomponen pada herbal tersebut jika digunakan bersamaan dengan OAH berpotensi untuk menimbulkan interaksi, beberapa studi melaporkan bahwa OAH dan herbal untuk antidiabetes memiliki interaksi sinergis atau antagonis. Berdasarkan pustaka beberapa penelitian interaksi obat dan herbal bisa terjadi, seperti Metformin, Glibenklamid dan Pioglitazon dengan Aloe vera berinteraksi sinergis. Kesimpulan: Potensi interaksi antagonis dan sinergis muncul pada beberapa hasil penelitian interaksi herbal dengan OAH.

In the absence of effective pharmacological therapy options, the focus of dementia and Alzheimer’s research has shifted from treatment and care to risk prediction, early detection, and prevention. Public health communication and media coverage regarding dementia emphasize the individual responsibility for dementia risk management. Focusing on the social and moral implications of the new understanding and public representation of dementia, we present an analysis of medical science, nursing science, and media discourses in Germany between 2014 and 2019. We show which notions of dementia and prevention characterize the medical and nursing science debates regarding dementia and how scientific knowledge is transferred into media discourses on dementia. We further discuss how dementia risk communication interacts with contemporary social and health policies and in what ways current dementia discourses are associated with a (self-)responsibilization of cognitive aging.

The objective was to evaluate the immediate results of treatment of patients with symptomatic form of myocardial bridges of the coronary arteries.Methods and materials. In the course of a retrospective study, the results of treatment of 70 patients who had underwent drug treatment and 52 patients who had underwent surgical treatment were analyzed. All the subjects had high functional angina pectoris.Results. Pharmacological therapy showed significant positive dynamics in 18 (25.7 %) patients. Analysis of the intraoperative and early postoperative periods in patients who underwent supracoronary myotomy allows us to conclude that surgical treatment of patients with myocardial bridges of the coronary arteries shows satisfactory results.Conclusion. Drug therapy may be effective in some patients with myocardial bridges of the coronary arteries. In case of ineffectiveness of pharmacological treatment, the possibility of performing surgery in the amount of supracoronary myotomy should be considered.

Background: Lack of insulin or the inability of cells to respond to insulin causes high blood glucose levels or hyperglycemia, a hallmark of diabetes. Consumption of foods with a low glycemic index and high fiber has been shown to provide the same benefits as pharmacological therapy in the control of postprandial hyperglycemia and can prevent the incidence of hypoglycemia in people with diabetes. Ganyong (Canna edulis) is a food source of carbohydrates and fiber. Kelor (Moringa oliefera) contains protein and some phytochemical compounds which have a hypoglycemic effect. Objective s : The objective of the study was to analyze the glycemic index of ganyong-kelor snack bars as a diet for diabetics. Materials and Method s : Ten respondents fasted for 10 hours and checked their fasting blood glucose levels, then consumed 105 grams of bread as the reference food. Every 30 minutes after eating, the blood glucose levels were checked. In the following week, after fasted, all respondents consumed 157 grams of a ganyong-kelor snack bar and checked their blood glucose levels every 30 minutes. Results : Every 100 grams of ganyong-kelor snack bar contains 230.13 kcal, 31.97 grams of carbohydrates, 9.25 grams of fat, and 4.75 grams of protein. In this study, bread was used as a reference food. If bread was corrected with glucose as a reference food, the glycemic index of the ganyong-kelor snack bar was 38.08. The calculation of the glycemic load used the converted-glycemic index and the total carbohydrates contained in 100 grams of the food. Ganyong-kelor snack bar had a glycemic load value of 12.10. Conclusions: Ganyong-kelor snack bar had good nutritional content and was categorized as food with a low glycemic index. The hypoglycemic effect of the ganyong-kelor snack bar came from its high fiber content. Ganyong-kelor snack bar can be consumed as a healthy snack for diabetic people.

Objetivo: Avaliar o nível de resiliência e de religiosidade em pacientes com insuficiência renal crônica, bem como investigar a influência destes elementos na adesão ao tratamento e à terapia farmacológica. Método: O estudo é de abordagem descritiva, transversal e correlacional. Foram incluídos 60 pacientes em hemodiálise. Utilizou-se o prontuário eletrônico para levantamento do início do tratamento e das faltas, bem como os instrumentos: questionário para caracterização pessoal, Escala de Resiliência de Wagnild e Young, Escala de Religiosidade de Duke e Escala de Adesão à Terapêutica de oito itens de Morisky. A análise dos dados iniciou-se com a estatística descritiva, seguida do teste de correlação de Spearman (p

El término cistopatía diabética describe el aumento de la capacidad de la vejiga y los volúmenes residuales postmiccionales en pacientes diabéticos, acompañado de disminución de la sensación y contracción vesical, atribuida a la neuropatía diabética. La cistopatía diabética es principalmente una enfermedad originada por una neuropatía, de origen sensorial y autonómica por las alteraciones que sufre en la fibras nerviosas; en este articulo se revisaran las múltiples teorías acerca de la fisiopatología. Los pacientes cursan con una sintomatología insidiosa y cuando es detectable se encuentra en una fase avanzada, el principal síntoma es la incontinencia urinaria. Su diagnóstico se establece mediante la presentación clínica asociada a sintomatología neurológica y se confirma con estudios de urodinamia. El control estricto y apego al tratamiento de DM2, es la piedra angular para evitar complicaciones a largo plazo, entre ellas la “Cistopatía Diabética”. Si ya esta establecida la enfermedad el tratamiento farmacológico esta indicado, con una amplia gama de fármacos a elegir; si no es candidato a terapia farmacológica o presenta sintomatología severa el manejo es quirúrgico con varias opciones quirúrgicas como la denervación vesical o la miomectomía.

Although pulmonary endarterectomy (PEA) is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH), many patients have inoperable disease, and some have persistent or recurrent pulmonary hypertension (PH) after surgery. Alternative options (balloon pulmonary angioplasty (BPA) and PH-targeted medical therapy) are, therefore, required. Studies of medical therapies for CTEPH have evolved since Aerosolized Iloprost Randomized (AIR), the first randomized, controlled study of a PH-targeted therapy (inhaled iloprost) to include patients with CTEPH. Key learnings from these studies include the need to evaluate CTEPH separately from other types of PH, the importance of prospective operability adjudication as part of the protocol, and the need for sufficient duration to allow treatment benefits to become apparent. The 16-week Chronic Thromboembolic Pulmonary Hypertension Soluble Guanylate Cyclase-Stimulator Study 1 (CHEST-1) study was the first to operationalize these learnings, demonstrating a significant mean improvement in 6-minute walk distance (+46 m) and improvements in hemodynamic endpoints with riociguat versus placebo. Findings from previous studies will inform the design of future studies to address key issues related to combination medical therapy. Data on combinations of macitentan with phosphodiesterase type 5 inhibitors or oral prostanoids are available from MERIT, the first study to allow such regimens. No data on combinations including riociguat, the only licensed medical therapy for CTEPH, are available. Studies are also needed for multimodality treatment, including medical therapy plus BPA, and medical therapy as a bridge to PEA in selected operable patients. To address these issues and improve patient outcomes, it is vital that we learn from current studies to improve future trial design.

Journal of endovascular therapy 28(4), 604-613 (2021). doi:10.1177/15266028211009272, Published by Sage, Thousand Oaks, Calif.

Due to the high adaptability of Helicobacter pylori and the low targeting specificity of the drugs normally used in pharmacological therapy, the strains are becoming increasingly resistant to these drugs, making it difficult to eradicate the infection. Thus, the search for new therapeutic approaches has been considered urgent. The incorporation of drugs in advanced drug delivery systems, such as nano and microparticles, would allow the improvement of the retention time in the stomach and the prolongation of drug release rates at the target site. Because of this, the present review article aims to highlight the use of micro and nanoparticles as important technological tools for the treatment of H. pylori infections, focussing on the main nanotechnological systems, including nanostructured lipid carriers, liposomes, nanoemulsion, metallic nanoparticles, and polymeric nanoparticles, as well as microtechnological systems such as gastroretentive dosage forms, among them mucoadhesive, magnetic and floating systems were highlighted.

Background: Whether pharmacological therapy alters decline in forced expiratory volume in 1 second (FEV1) in chronic obstructive pulmonary disease (COPD) remains controversial. Because pharmacother...

Luis Pérez de Llano, David Dacal Rivas, Nagore Blanco Cid, Irene Martin Robles Head of the Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo. C/ Doctor Ulises Romero, nº 1, Lugo, 27003, SpainCorrespondence: Luis Pérez de LlanoHead of the Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo, C/Doctor Ulises Romero, nº 1, Lugo, 27003, SpainTel +34 982296000Email eremos262@hotmail.comAbstract: Despite recent advances in therapy, a substantial proportion of asthmatics remain not well controlled. The classical stepwise approach to pharmacological therapy in adult asthma recommends that treatment is progressively stepped up by increasing the inhaled corticosteroid (ICS) dose or by adding another controller medication- to achieve symptom control and reduce the risk of exacerbations, and stepped down after a period of control. In general, asthma guideline recommendations do not reflect that there are significant differences between ICS in terms of potency. Moreover, they do not consider efficacy and safety separately, incorrectly assuming that “low” and “high” dose categories inevitably correspond with low and high risk of systemic effects. Another point of criticism is the fact that guidelines do not take into account the inflammatory profile of the patient, although substantial groups of patients with mild and moderate asthma have little evidence of “T2-high” inflammation, and by extension are likely to show a poor response to ICS treatment. On the other hand, the latest version of the Global Initiative for Asthma (GINA) equally recommends regular ICS and ICS/formoterol as needed to prevent exacerbations in step 2 patients, without taking into consideration that the therapeutic objectives (exacerbations, symptoms) may differ between individual patients and that different goals may warrant distinct treatment strategies. In this review, we bring to the table several controversial issues concerning asthma treatment and suggest an alternative proposal that takes into consideration the potential side effects of high ICS doses, the patient’s inflammatory profile and the therapeutic goals to be achieved.Keywords: asthma, asthma treatment, asthma phenotype, asthma endotype, personalized medicine

Chronic musculoskeletal pain (CMP) is a common occurrence in clinical practice and there are a variety of options for the treatment of it. However, the pharmacological therapy is still considered to be a primary treatment. The recent years have witnessed the emergence of opioid crisis, yet there are no relevant guidelines on how to treat CMP with non-opioid analgesics properly. The Chinese Medical Association for the Study of Pain convened a panel meeting to develop clinical practice consensus for the treatment of CMP with non-opioid analgesics. The purpose of this consensus is to present the application of nonsteroidal anti-inflammatory drugs, serotonin norepinephrine reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, muscle relaxants, ion channel drugs and topical drugs in CMP.

Psoriatic arthritis (PsA) is an inflammatory chronic arthritis associated with psoriasis. Currently, data about gender differences in clinical manifestation and therapeutic outcomes of PsA are limited. Frequently, women manifest a peripheral disease while men have an axial localization. Moreover, women display higher disease activity and physical activity limitations, if compared to men. Although the involvement of the temporomandibular joint (TMJ) is quite rare, it can seriously impact the quality of life. The morpho-functional peculiarities of TMJ require a multidisciplinary approach to perform a correct diagnosis and a successful treatment. Here, we report a case of a woman affected by PsA involving TMJ treated by combining pharmacological therapy and an occlusal splint. The coordination between different specialties led to a complete remission of clinical symptoms and a regression of lesions.

Introduction: Heart failure is a major public health concern that is expected to increase over the decades to come. Despite significant advances, fluid overload and congestion remain a major therapeutic challenge. Vascular congestion and neurohormonal activation are intricately linked and the goal of therapy fundamentally aims to reduce both.Areas covered: The authors briefly review a number of core concepts that elucidate the link between fluid overload and neuro-hormonal activation. This is followed by a review of heart-kidney interactions and the impact of diuresis in this setting. Following an in-depth review of currently available pharmacological agents, the rationale and evidence behind their use, the authors end with a brief note on novel agents/approaches to aid volume management in HF.Expert opinion: A number of non-pharmacological advances in the management of volume overload in heart failure, though promising - are associated with a number of shortcomings. Pharmacological therapy remains the cornerstone of volume management. A number of novel approaches, utilizing existing therapies as well as the emergence of new agents over the past decade bode well for the vulnerable HF population.

Right ventricular failure (RVF) following left ventricular assist device (LVAD) implantation remains a major complication which may significantly impair patient outcome. The genesis of RVF is, however, multifactorial, and the mechanisms underlying such a condition have not been fully elucidated, making its prevention challenging and the course not always predictable. Although preoperative risks factors can be associated with RV impairment, the physiologic changes after the LV support, can still hamper the function of the RV. Current medical treatment options are limited and sometimes, patients with a severe post-LVAD RVF may be unresponsive to pharmacological therapy and require more aggressive treatment, such as temporary RV support. We retrieved 11 publications which we assessed and divided in groups based on the RV support [extracorporeal membrane oxygenation (ECMO), right ventricular assist device (RVAD), TandemHeart with ProtekDuo cannula]. The current review comprehensively summarizes the main studies of the literature with particular attention to the RV physiology and its changes after the LVAD implantation, the predictors and prognostic score as well as the different modalities of temporary mechanical cardio-circulatory support, and its effects on patient prognosis for RVF in such a setting. In addition, it provides a decision making of the pre-, intra and post-operative management in high- and moderate- risk patients.

Cochlear implantation (CI) has developed for more than four decades. Initially, CI was used for profound bilateral hearing impairment. However, the indications for CI have expanded in recent years to include children with symptomatic partial deafness. Therefore, CI strategies to preserve residual hearing are important for both patients and otologists. The loss of residual low-frequency hearing is thought to be the result of many factors. All surgical methods have the same goal: protect the delicate intracochlear structures and preserve residual low-frequency hearing to improve speech perception abilities. Fully opening the round window membrane, a straight electrode array, slower insertion speed, and the use of corticosteroids result in a higher rate of hearing preservation. Several factors, like the way of surgical approaches, length of arrays and timing of activation, may not affect the residual hearing preservation. Therefore, the classic atraumatic technique, including the very slow and delicate insertion and administration of intraoperative corticosteroids, can improve hearing outcomes.

ZusammenfassungWissenschaftliche Erkenntnisse der letzten Jahrzehnte lassen vermuten, dass Veränderungen im Bereich des subchondralen Knochens in der Genese und Progression der Arthrose mitverantwortlich sind. Vordergründig scheinen hierfür mechanische Faktoren wie Achsfehlstellung und Instabilität verantwortlich. Die Veränderungen im subchondralen Knochen sind biphasisch. Primär kommt es durch ein erhöhtes Remodeling zu einer Reduktion des Knochenvolumens im Bereich des subchondralen Knochen, sekundär zu einer Dichtezunahme und Abnahme der Gewebsmineralisation. Die veränderten strukturellen Gegebenheiten des Knochens begünstigen die Progression der Knorpeldegeneration. Medikamente, die das Bone Remodeling beeinflussen, werden daher auch als potenzielle Behandlungsoptionen für die Arthrose betrachtet.

The appropriate medical treatment for gestational diabetes mellitus (GDM) is controversial and recommendations vary between different organizations.To compare the safety and efficacy of glyburide and insulin as treatments for GDM.Retrospective analysis of all pregnant women diagnosed with GDM and treated with either glyburide or insulin. Demographic features, clinical characteristics, maternal and neonatal outcomes were compared according to type of pharmacological treatment.Included in the study were 323 women, of whom 269 (83.28%) were treated with glyburide and 54 (16.72%) with insulin. There were no significant differences between the groups, apart from a higher one-hour oral glucose tolerance test (OGTT) value (191.80 mg/dl in the glyburide group, 204.33 in the insulin group,Glyburide is at least as safe and effective as insulin except for higher rates of maternal hypoglycemia. Considering its advantages compared to insulin (ease of use and storage, increased patient responsiveness, and lower cost), it may be considered as first line treatment in GDM, especially when fasting OGTT value is not high.

Osteoporosis is a symptomless disease resulting in an increased risk of low-trauma fracture, common fracture sites including the wrist, spine and hip. Comprehensive clinical guidelines for the diagnosis and treatment of osteoporosis in adults include those produced by the National Institute for Health and Care Excellence, National Osteoporosis Guideline Group and Scottish Intercollegiate Guideline Network. However, older people bear the greatest health burden from osteoporosis and the applicability to this age group of guidelines, clinical risk factors and bone mineral density (BMD) measurements must be considered. Fracture risk estimation can be used to identify patients at highest fracture risk, either with or without BMD, and treatment targeted at those most likely to benefit. Lifestyle factors, including exercise and diet, are important in fracture prevention, although the evidence to support these in treating osteoporosis needs further assessment. Ultimately, pharmacological therapy is likely to be necessary in those at greatest fracture risk. In approaching treatment decisions, benefits and risks of therapy must be balanced to reach a shared care agreement, with patients (and their carers). Generally the benefits of treatment are likely to outweigh risks of adverse outcomes for patients at high risk of osteoporotic fracture.

Chronic obstructive pulmonary disease has recently been gaining more attention, as beyond impacting roughly 10% of the world's population, it also carries high morbidity and mortality. The mainstay of management is optimizing pharmacological therapy, but various nonpharmacological therapies have shown benefits in providing symptom improvement and relief, prevention and mitigation of exacerbations, quality of life, and even mortality rate. Such modalities include supplemental oxygen therapy, pulmonary rehabilitation, viral and bacterial vaccinations, and noninvasive positive pressure ventilation therapy.

BACKGROUND: At present, there is no pharmacological therapy that can cure Alzheimer’s disease. Treatment is only limited to preventing progression and controlling risk factors that worsen Alzheimer’s. Medium-chain triglycerides (MCT) are nutritional therapies that are being studied to prevent the progression of Alzheimer’s disease. AIM: This study aims to see the effect of giving MCT to the value of percentage alternation Y-maze test and serum Aβ-42 levels as a marker of Alzheimer’s disease. MATERIALS AND METHODS: This study is an experimental study using postp-test control group design. Samples from this study were 30 Sprague Dawley rats which were divided into positive control groups, negative controls, and three treatment groups. Positive control group and treatment were induced by Alzheimer’s by ovariectomy and d-galactose. After induction, MCT were given to the treatment group for 6 weeks. After treatment, the levels of Aβ-42 serum were examined by ELISA and cognitive function was examined by Y-maze. After that, the data were analyzed by ANOVA. p < 0.05 was said to be statistically significant. RESULTS: The results showed that this study was found a moderate relationship with a positive pattern. This means that the higher the percentage alternation value, the higher the level of Aβ-42 in serum which indicates that the higher the percentage alternation value, the higher the clearance of Aβ-42. CONCLUSION: This study concluded that the group of rats given MCT has a serum Aβ-42 level higher than the group of rats that were not given MCT.

ZUSAMMENFASSUNGDie amyotrophe Lateralsklerose (ALS) stellt mit ihrer fehlenden kausalen Therapierbarkeit und ihren zahlreichen Symptomen eine große Herausforderung für alle Behandelnden und Begleitenden dar. Neben dem Medikament Riluzol, wodurch eine kurze Lebenszeitverlängerung bewirkt werden kann, befinden sich mehrere Wirkstoffe im Stadium der Erprobung im Rahmen von Studien. Für die symptomatische Behandlung der ALS liegen nur wenige randomisierte, placebokontrollierte Studien vor. Die vorliegende Arbeit gibt eine Übersicht über die pharmakologischen und nicht pharmakologischen Therapiemöglichkeiten bei ALS. Es wurden die Datenbanken CENTRAL, Medline, PsycINFO und Pubmed nach Artikeln in englischer Sprache bis August 2018 durchsucht. Die Entwicklungen nach dem Beobachtungszeitraum werden in einem gesonderten Abschnitt behandelt. Mit der systematischen Suchstrategie wurden 232 Publikationen identifiziert, wovon 34 in die Übersicht eingeflossen sind, ein Artikel aus anderer Quelle wurde hinzugefügt. Hierunter befanden sich 9 kontrollierte Studien, von denen 7 die Wirksamkeit therapeutischer Medikamente bei ALS untersuchen. Ein Großteil der Studien basiert auf geringen Patientenzahlen mit sehr unterschiedlichen Angaben zur Effektivität der jeweiligen Interventionen. Neben der Behandlung mit Riluzol 2x50mg/d stellen die nicht invasive Beatmung (NIV), die Versorgung mit einer perkutanen endoskopischen Gastrostomie (PEG) sowie die Betreuung durch ein multidisziplinäres Team Faktoren dar, die die tracheotomiefreie Überlebenszeit der Patienten verlängern können. Die Durchführung weiterer randomisierter, kontrollierter Studien mit höheren Patientenzahlen auch im Bereich der symptomatischen Therapien wird von fast allen zitierten Autoren angeregt. Da die Behandlung mit Riluzol, die Versorgung mit NIV, einer PEG sowie die Anbindung der Patienten an ein multidisziplinäres Team hinsichtlich Überlebenszeit und Erhalt der Lebensqualität relevant sind, gilt es, den Patienten diese Optionen zum geeigneten Zeitpunkt zur Verfügung zu stellen.

Duchenne muscular dystrophy (DMD) is the most frequent genetic neuromuscular disease in childhood with loss of ambulation usually occurring around the age of 9-11 years.Based on current guidelines and clinical trials, neuropediatric and neurological experts developed recommendations for the treatment of nonambulatory DMD patients focusing on drug treatment of adults. This advisory board was sponsored by PTC Therapeutics, the distributers of the substance ataluren.Loss of ambulation is heterogeneously defined across clinical trials. Among others, the need of a wheelchair, ambulation without mobility aids or maximum walking distance can be suitable parameters for assessment. Treatment of DMD patients at any stage of the disease is based on supportive and symptomatic measures, which should be continued after loss of ambulation. In addition, disease-modifying drugs are available for the treatment of DMD and glucocorticoids are the usual standard of care treatment even beyond the loss of ambulation. Ataluren, a potentially dystrophin restorative, disease-modifying treatment, has been approved for patients with DMD due to a nonsense mutation (nmDMD), which applies to approximately 13% of DMD patients and is usually combined with steroids. Clinical data from the STRIDE registry demonstrated a delayed disease progression even after loss of ambulation. Currently, no reliable data are available for exon skipping approaches in adult DMD patients. The antioxidant idebenone could be an option in nonambulant adolescent patients not treated with glucocorticoids and without other therapeutic options. A combination treatment of idebenone and glucocorticoids is currently being investigated in a clinical trial. Add-on treatment with idebenone in addition to ataluren may be considered for nonambulant nmDMD patients. Some of the discussed treatment options are still in clinical trials or there are not enough data for older DMD patients; therefore, these expert recommendations correspond to evidence class IV.HINTERGRUND: Die Muskeldystrophie Duchenne (DMD) ist die häufigste genetische neuromuskuläre Krankheit im Kindesalter, bei der es meist im Alter von 9 bis 11 Jahren zum Verlust der Gehfähigkeit kommt.Auf der Grundlage aktueller Leitlinien und Studien erarbeiteten neuropädiatrische und neurologische Experten im Rahmen eines von der Firma PTC Therapeutics GmbH (Frankfurt am Main, Deutschland), die die Substanz Ataluren vertreibt, gesponserten Advisory Boards Empfehlungen zur Behandlung nichtgehfähiger Patienten mit DMD mit Schwerpunkt medikamentöse Therapien von Erwachsenen.Der Verlust der Gehfähigkeit wird in Studien sehr unterschiedlich definiert und bezieht sich u. a. auf die Rollstuhlpflicht, das selbständige Gehen ohne Hilfsmittel oder die maximale Gehstrecke. Grundlage der Therapie von Patienten mit DMD in jedem Krankheitsstadium sind supportive und symptomatische Maßnahmen, die in der Regel auch nach dem Verlust der Gehfähigkeit intensiv weitergeführt werden sollten. Zusätzlich stehen den Patienten medikamentöse Therapien mit dem Ziel der Modifikation des Krankheitsverlaufes zur Verfügung. Glukokortikoide bilden den Stützpfeiler der medikamentösen Therapie auch über den Verlust der Gehfähigkeit hinaus, dann meist in reduzierter Dosis. Für Patienten mit DMD aufgrund einer Nonsense-Mutation (nmDMD), ca. 13 % aller DMD-Patienten, steht Ataluren als potenziell dystrophinwiederherstellende, krankheitsmodifizierende Therapie zur Verfügung; klinische Daten aus dem STRIDE-Register zeigen eine verzögerte Krankheitsprogression auch nach Verlust der Gehfähigkeit. Zum Exon-Skipping liegen für erwachsene Patienten derzeit noch keine belastbaren Daten vor. Das Antioxidans Idebenon kommt bei nichtgehfähigen, jugendlichen Patienten ohne therapeutische Alternative, die nicht mit Glukokortikoiden behandelt werden können, infrage. Ataluren eignet sich zur kombinierten Behandlung mit Glukokortikoiden, eine Kombination von Idebenon und Glukokortikoiden wird derzeit in einer klinischen Studie überprüft. Eine Add-on-Therapie mit Idebenon zusätzlich zu Ataluren ist bei nichtgehfähigen nmDMD-Patienten zu erwägen. Bedingt durch die Tatsache, dass sich einige der diskutierten Therapieoptionen noch in der Phase der klinischen Prüfung befinden oder noch keine oder nur begrenzte Daten für ältere Patienten mit DMD vorliegen, handelt es sich um Expertenempfehlungen entsprechend der Evidenzklasse IV.

Background: Primary percutaneous coronary intervention (PCI) with stent implantation has been the standard therapy in acute ST-segment elevation myocardial infarction (STEMI) patients. Compared with medical treatment alone, stent implanting can achieve larger lumen gain and helps to reduce the re-occlusion risk of the infarct-related artery. Purpose: The aim of this study was to compare the effectiveness of stenting of single vessel intermediate culprit lesion stenosis to pharmacological treatment alone in acute STEMI patients. Methods: This study was prospective comparative interventional case series. It included 60 patients admitted to coronary care unit of our University hospital with acute STEMI. All patients were subjected to detailed history taking, clinical examination, 12 leads ECG, echocardiography and cardiac catheterization and angiography (TIMI flow and corrected TIMI frame count (CTFC) was reported. Patients selected were those with intermediate culprit lesion (40-70%) single vessel stenosis. Patients were divided into 2 groups: Group A: 30 patients who underwent stenting of the culprit lesion in addition to standard pharmacological treatment. Group B: 30 patients who received pharmacological treatment and no stenting (Glycoprotein II b/IIIa inhibitor in addition to the standard pharmacological treatment). Patients were followed up for 12 months and major adverse cardiac events (MACE) were reported (death, myocardial infarction, coronary re-vascularization, stroke and hospitalization because of heart failure). Results: 63.3% of group A patients reported complete ST segment resolution versus 30% of group B (P=0.034). TIMI Flow showed statistically significant difference in group A compared to group B regarding (P value=0.005) Group A reported slow fast blood flow (CTFC0.05). Conclusion: Stent implantation reported better immediate efficacy and safety results among acute STEMI patients with single vessel intermediate culprit lesion stenosis and favourable effects in reducing MACE.

Post partum hypertension contributes to maternal mortality. Postpartum hypertension management can be in the form of pharmacological therapy, but it causes side effects for mother and baby. Several studies have shown that chayote can play a role in lowering blood pressure. This research aimed to prove the effect of chayote extract on reducing blood pressure in postpartum with hypertension. Quasy experiment pretest and posttest control group design. The number of samples was 19 interventions and 19 controls. The intervention group received 400 mg of chayote extract and 10 mg of nifedipine, while the control group received only 10 mg of nifedipine. The intervention was carried out for 7 days. The treatment group experienced significant changes in systolic blood pressure and diastolic blood pressure with p value = 0.000 compared to the control group. The chayote extract has a significant effect on reducing blood pressure in postpartum with hypertension

One of the needs of mothers in labor is the reduction of pain or pain. Pain reduction techniques during labor consist of pharmacological therapy and nonpharmacological therapy. One of the non-pharmacological methods of reducing labor pain is Slow Stroke Back Massage (SSBM). This study aims to determine the effect of SSBM on the reduction of active phase pain in the first stage of labor of primigravida mothers in Lamsiah Clinic in 2020. Quantitative research methods. This type of research is a quasi-experimental design with nonequivalent control group design. The study population was all primigravida mothers giving birth at the Lamsiah Clinic as many as 30 people. The sample selection uses purposive sampling and the number uses the Lameshow formula as many as 16 people as the intervention group and 16 others as the control group. The results of the study using the T test showed that the intervention group obtained p-value = 0,000. While in the control group, the value of p-value = 0.333 was obtained. The conclusion is that the effect of a SSBM massage on the reduction of pain in the active phase in the first labor of primigravida mothers in the intervention group, but in the control group, no significant effect. It is expected that health workers in the Lamsiah Clinic will provide health education to mothers during ANC on non-pharmacological efforts in the form of a SSBM massage as an effort to reduce labor pain intensity.

La psoriasis es una de las enfermedades dermatológicas más comunes, que puede comprometer a pacientes feme­ninas en edad fértil, embarazo o posparto. Sus manifestaciones se caracterizan en tipos de lesiones, extensión, gravedad, compromiso sistémico y afectación de la calidad de vida. El embarazo es una etapa de cambios fisio­lógicos, que, en relación con la psoriasis, su evolución es incierta, ya que en ocasiones se disminuye o resuelve y en otras se exacerba de tal forma que se requiere de manejo farmacológico. En el siguiente trabajo, se explican las posibles etiologías, la fisiopatología, los diferentes tipos de lesiones, diag­nóstico, tratamiento y posibles complicaciones, tanto maternas como fetales. Uno de los objetivos principales en el embarazo es buscar la seguridad materna y fetal, por lo que se explican los tratamientos clasificados según la FDA, evaluando el riesgo-beneficio, para desarrollar un documento útil para la práctica clínica.

El cáncer de colon es una de las principales causas de muerte a nivel mundial, en este sentido, a pesar de que se ha reducido la tasa de mortalidad, la incidencia en pacientes jóvenes sigue aumentando. El presente trabajo consiste en una revisión bibliográfica descriptiva de la relación existente entre la microbiota, la epigenética y la respuesta a medicamentos utilizados para tratar el cáncer de colon. Dicha revisión es elaborada a partir de la consulta de las bases de datos disponibles en la plataforma del Sistema de Bibliotecas, Documentación e Información (SIBDI) de la Universidad de Costa Rica. El objetivo central de este estudio es entender la relación existente entre la microbiota y la epigenética para así poder usar estos conocimientos en favor de la optimización de la terapia farmacológica y, además, predecir respuestas a medicamentos en el cáncer de colon. Se encontró evidencia que sugiere que el tipo de dieta impacta directamente en la microbiota intestinal, la cual, por su parte, puede tener un efecto pro o anti cancerígeno, dependiendo de las modificaciones epigenéticas dadas por metabolitos de estas bacterias y que pueden modificar la respuesta a la quimioterapia. Se concluye que el cáncer de colon es de origen multifactorial, por lo que se afirma que se ve afectado por eventos genéticos: la dieta, el estilo de vida, la microbiota y sus metabolitos. Finalmente, es promisorio encontrar maneras para asociar concretamente microbiota relacionada con los cambios de respuesta a medicamentos y así optimizar las terapias oncológicas. Globally, colon cancer is one of the main causes of death, although its death rate has decreased, the incidence in young patients is increasing. This research consists in a descriptive bibliographic review of the relationship of the microbiota, epigenetics and the response to drugs used in colon cancer, elaborated from the bibliographic on-line platform (SIBDI) that the University of Costa Rica makes available to researchers. In addition to that, the objective of this study is to understand the relationship between the microbiota and epigenetics to use that knowledge to optimize pharmacological therapy and predict response to colon cancer drugs. Moreover, as a result: evidence was found that supports that the diet impacts directly in the intestinal microbiota and can have pro or anticancer effects depending on the epigenetic modifications given by the metabolites provided by the types of bacteria present in the gut that can modify drug response. Finally, this research concludes that Colon cancer has a multifactorial origin and it can be affected by genetic events, diet, lifestyle, and microbiotas metabolites. It provides promising search for new ways to associate specific bacteria and changes in colon cancer drug response. Universidad de Costa Rica/[]/UCR/Costa Rica UCR::Vicerrectoría de Docencia::Salud::Facultad de Farmacia

Cardiac contractility modulation (CCM) is a new implantable device that transmits electrical impulse to the heart during the absolute refractory period, which leads to an increase in myocardial contractility. This pacemaker works on several molecular levels and is dedicated to patients with heart failure (HF). The therapeutic effect is mainly due to the improvement in the circulation of calcium ions inside the cardiomyocytes. The final CCM effect leads to improved exercise capacity, increased quality of life, decreased symptoms and the number of hospitalizations as the results of HF. Device is an important alternative for patients with ineffective pharmacological therapy, who are not eligible for CRT implantation due to the narrow QRS complex, have a decreased ejection fraction, and in the New York Heart Association scale they were classified on the II–III degree. Previous studies have not demonstrated the impact of CCM on life expectancy. The effect of cardiac contractility modulation device on the improvement of everyday functioning and the reduction of hospitalization has been proven, which is important in the long-term perspective for both individual patients and the entire health care system. The case report shows an example of a patient for whom CCM was an addition to treatment.

During the period of pregnancy, several processes and physiological adaptations occur in the body and metabolism of pregnant woman. These physiological adaptations in pregnant woman end up leading to a suppression in immune system favoring obstetric complications to the mother, fetus and placental tissue. An effective pharmacological therapy for these complications is still a challenge, since some drugs during pregnancy can have deleterious and teratogenic effects. An emerging alternative to pharmacological therapy during pregnancy is drugs encapsulated in nanoparticles (NP), recent area called nano-obstetrics. NP have the advantage of drug targeting and reduction of side effects. Then, maternal, placental or fetal uptake can be expected, depending on the characteristics of NP. Inorganic NP, crossing placental barrier effectively, but have several nanotoxicological effects. While organic NP appear to have a better targeting capacity and have few toxicological effects, but the studies are still scarce. Thus, in this review, were examined questions related to use and impact of physicochemical aspects of inorganic and organic NP during pregnancy., Highlights • Use of organic and inorganic nanoparticles during pregnancy. • Impact of use of nanotherapy in pregnancy. • Role of inorganic nanoparticles in nanotoxicological effects during pregnancy.

Although cardiologists frequently assist patients who suffer damage from smoking, the degree of training they receive to manage this problem during their residency is unknown. Because of this, we’d proposed to ­evaluate the preferences and practices of cardiology residents for smoking cessation of the attending patients.Closed, prefixed, voluntary and anonymous survey among doctors who carried out the specialty of cardiology in 5 countries of Latin America and Spain.716 residents were surveyed; 62.4% from Argentina, 19% from Mexico, 6.8% from Spain, 6.7% from Chile, 3.2% from Uruguay, and 1.9% from Paraguay. When asked about the importance they assigned to this problem (using a scale of 1-10), 85.8% assigned this question a score of 8 or higher. While 80.5% of the participants expressed giving short anti-tobacco advice routinely, only 27.7% used pharmacological therapy for this purpose. Among those who did not use pharmacological therapy, 58.3% said that the reason was not being familiar with the treatments; 62.9% of the surveyed said they had not received any type of training in this problem. Those residents who received some type of training reported feeling more prepared for this (p0.0001).We found that cardiology residents have a low knowledge of pharmacological treatment and relatively low confidence to provide assistance in smoking cessation. This topic should be included in the training of future cardiologists in order to achieve a more comprehensive cardiovascular prevention.Si bien los cardiólogos asisten cotidianamente a pacientes que sufren daño por el tabaquismo, no se conoce el grado de formación que reciben sobre esta problemática durante su residencia. Debido a ello nos propusimos evaluar las preferencias y prácticas de los residentes de cardiología para la cesación tabáquica de los pacientes que asisten.Encuesta cerrada, prefijada, voluntaria y anónima entre médicos que realizaban la especialidad de cardiología en cinco países de Latinoamérica y España.Se encuestaron 716 residentes: un 62.4% de Argentina, un 19% de México, un 6.8% de España, un 6.7% de Chile, un 3.2% de Uruguay y un 1.9% de Paraguay. Con respecto a la importancia que asignaban a esta problemática (empleando una escala de 1-10), el 85.8% le asignó a esta pregunta una puntuación de 8 o mayor. Mientras el 80.5% de los participantes expresó dar consejo breve antitabáquico sistemáticamente, solamente un 27.7% empleaban terapia farmacológica con este fin. Entre quienes no empleaban terapia farmacológica, el 58.3% manifestó que el motivo era no encontrarse familiarizados con los tratamientos. El 62.9% de los encuestados dijo no haber recibido ningún tipo de formación en esta problemática. Aquellos residentes que recibieron algún tipo de formación manifestaron sentirse más preparados (p0.0001).Encontramos un bajo conocimiento sobre el tratamiento farmacológico y relativamente poca seguridad por parte de los residentes de cardiología para brindar asistencia en cesación tabáquica. Consideramos esencial incluir este tópico en la formación de los futuros cardiólogos a fin de lograr una prevención cardiovascular más integral.

The atherosclerotic cardiovascular disease (ASCVD) represents the leading cause of death and disability in the elderly. The study of atherosclerosis and the strategies to control ASCVD are evolving. All strategies emphasize the need to lower LDL cholesterol (LDL-C) through an appropriate lifestyle and the use of lipid-lowering drugs, mainly statins. Available evidence coming from clinical trials is useful to inform clinical choices, but the older people are poorly represented in those trials. Thus, evidence supporting the benefit of statin therapy for primary and secondary prevention of fatal and nonfatal ASCVD events in adults aged 75 years and older are limited. The pharmacological therapy of dyslipidemia is recommended by guidelines provided by international expert panels in adults, while in the elderly it is still a matter of debate. Statins are generally well tolerated drugs but their use in the elderly, especially in fragile ones or with multi-pathology that take many other drugs, requires a careful evaluation of the risk-benefit ratio and a shared decision- making process between doctor and patient.

Introduction Obstructive sleep apnea syndrome (OSAS) is a sleep related disorder resulting in apneic and hypopneic episodes during sleep. The purpose of this article is to present and discuss our experience with the "Thornton Adjustable Positioner" TAP Splint in a consecutive series of patients affected by OSAS. Methods The data of all patients affected by OSAS and with indication to oral appliance (OA) treatment at the Dentistry Department of the Vercelli Hospital between January 1, 2019, and December 31, 2019 were collected. The following data were recorded for each patient: gender; age; smoke and/or alcohol assumption; BMI; comorbidities and current pharmacological therapy; initial AHI; OSAS category; eventual performed OSAS treatment options before OA treatment; indication to OA treatment; final AHI following OA treatment; complications and side effects. Results A total of 18 subjects (11 men, 7 women) with a mean age of 58,8 years were enrolled in this study with a mean AHI of 27,9 (range 5,8-84). Average BMI was 29. OA treatment reduced AHI in all patients (mean post treatment AHI, 5; range, 3,1-8). All patients were satisfied with the subjective improvement of OSAS symptoms. Conclusions Our results confirm the usefulness of a specific type of mandibular advancement device that can be considered as a valuable therapeutic modality in OSAS patients. Side effects are limited and they usually do not decrease the compliance of patients.

BACKGROUND: Familial amyloid polyneuropathies (FAPs) are a group of rare autosomal dominant transmitted disorders that can progressively lead to disability from neuropathy, autonomic failure and other system involvement. OBJECTIVE: The aim of this commentary is to discuss Cochrane evidence on the efficacy and safety of disease-modifying drugs (DMDs) for the treatment of FAPs from a rehabilitation perspective. METHODS: To summarize and discuss from a rehabilitation perspective the published Cochrane Review “Pharmacological treatment for familial amyloid polyneuropathy” by Magrinelli et al. RESULTS: This Cochrane review included 4 randomized controlled trials (RCTs) involving 655 adults with FAP. These four trials compared four different DMDs with placebo. The Cochrane Systematic Review reported that current evidence is limited. CONCLUSIONS: FAPs are a group of chronic disabling conditions in which a multidisciplinary approach, including an adequate rehabilitation programme along with a long-term effective pharmacological therapy, should always be envisaged.

Os idosos figuram como os individuos mais polimedicados do mundo por questoes biopsicossociais. Estima-se que em 2025 existirao aproximadamente 1,2 bilhao de pessoas com mais de 60 anos, e em 2050 os idosos representarao 22,71% da populacao total. No Brasil, ate 2025, 15% da populacao sera idosa. O objetivo deste artigo foi abordar os perigos, tendencias e conflitos de interesse que envolvem a polimedicacao em idosos. Trata-se de um estudo de revisao sistematica da literatura feita em bases cientificas como o Google academico, no periodo de 2016 a 2020, nos idiomas Portugues, Ingles ou Espanhol. Os achados na literatura cientifica comprovam que quanto maior a idade, maior a vulnerabilidade biopsicossocial, em relacao as doencas cronicas nao transmissiveis, excesso de massa gorda, sedentarismo e disturbios psicologicos, principalmente estresse e ansiedade. Todos esses fatores, somados ao empenho em fidelizar clientes mediante a criacao da necessidade de consumo da industria farmaceutica e seus representantes, levam os prescritores a receitarem dois ou mais medicamentos ao publico idoso, muitas vezes irracional, reduzindo assim a qualidade de vida dos pacientes e elevando gastos em saude publica. Assim, uma terapeutica farmacologica clinica e racional diminui o quantitativo de medicamentos utilizados de forma segura, eficiente e eficaz, o que reduz os efeitos colaterais e os riscos de interacoes medicamentosas, de reacoes adversas, os custos, outrossim aumenta a qualidade de vida dos idosos. Essa terapeutica racional podera ocorrer mediante uma atencao farmaceutica adequada, sendo o farmaceutico, no âmbito macro da assistencia farmaceutica, norteador desse processo. Palavras-Chave: Saude do Idoso. Polimedicacao. Uso Racional de Medicamentos. Doencas Cronicas nao Transmissiveis. Assistencia Farmaceutica. ABSTRACT The elderly are the most polymedicated owners in the world for biopsychosocial reasons. It is estimated that in 2025 there will be approximately 1.2 billion people over the age of 60, and in 2050 the elderly represent 22.71% of the total population. In Brazil, by 2025 15% of the population will be elderly. The aim of the article was to address the dangers of these trends and conflicts of interest that involve polymedication in the elderly. This is a systematic literature review study carried out on scientific bases such as Google academic, in the period from 2016 to 2020, in Portuguese, English or Spanish. The findings in the scientific literature prove that the older the age, the greater the biopsychosocial vulnerability, in relation to chronic non-communicable diseases, excess fat mass, physical inactivity and psychological disorders, especially stress and anxiety. All of these factors, added to the commitment to retain customers by creating the need for consumption by the pharmaceutical industry and its representatives, lead prescribers to prescribe two or more medications to the elderly, often irrational public, as well as the quality of life of patients and increasing public health spending. Thus, a clinical and rational pharmacological therapy, the quantity of drugs used safely, efficiently and effectively, which reduces the effects caused and the risks of drug interactions, adverse reactions, costs, and also increases the quality of life of the elderly. This rational therapy can take place through adequate pharmaceutical care, with the pharmacist, in the scope of pharmaceutical assistance, guiding this process. Keyworlds: Health of the Elderly. Polymedication. Rational use of Medicines. Chronic Noncommunicable Diseases. Pharmaceutical Care.