Panminerva medica
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Randomized Controlled Trial Multicenter Study
Effect of neridronate in osteopenic patients after heart, liver or lung transplant: a multicenter, randomized, double-blind, placebo-controlled study.
Transplantation (Tx) is an effective therapeutic option in patients with end-stage organ failure and osteoporosis and related fractures are a recognized complication in these patients. Aim of this study was to evaluate the efficacy of neridronate in patients with reduced bone mass after Tx of the heart, liver or lung. ⋯ This is the first RCT that demonstrates the efficacy of neridronate in increasing bone density and reducing bone turnover in organ Tx recipients with significant skeletal morbidity.
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There is a rising burden of non-communicable disease (NCD), especially cardiovascular diseases (CVD) in the developing nations to an extent that they are sometimes terms as NCD epidemics. If unchecked, these NCD epidemics, can impact the healthcare systems and adversely affect the development of the whole country. While CVD is a matter of concern worldwide, it is even more so in low- and middle-income countries, where the incidence and prevalence of these diseases are much worse than developed countries, owning to their large population. ⋯ Therefore, the primordial prevention must start early in life. High-quality clinical trials have traditionally been mainly focusing on primary and secondary prevention settings. There are some key studies that evaluated the role of diet in primordial setting that were discussed in this review.
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Since CR was introduced, studies have been carried out to discover the effect of CRHPs on cardiovascular morbidity and mortality and on heart-disease patients' quality of life. The first meta-analyses showed improvement in cardiovascular morbidity and mortality, although the studies were conducted in the coronary pre-reperfusion era, before the generalized use in secondary prevention of drugs such as statins, beta-blockers, or renin-angiotensin-system inhibitors, which have produced a decrease in cardiovascular mortality. In Europe, analyzing 25 studies with more than 200,000 patients. ⋯ Compared to the usual treatments in cardiology, the patients who underwent CRHPs presented fewer readmissions for cardiovascular reasons (17% vs. 43.38%, P<0.001), fewer major cardiovascular events (11.9% vs. 27.2%, P<0.001) and new revascularizations (9.3% vs. 21.32%, P=0.001), with lower cardiovascular mortality (0 vs. 2.2%, P=0.014). It also led to better control of the RFCV (66% vs. 19.85%, P<0.001) and favored lifestyle changes in these patients (91% vs. 61%, P<0.001). Therefore, in our setting, the performance of CRHPs was shown to be effective in reducing cardiovascular morbidity and mortality and in the secondary prevention of coronary patients.
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The present study aimed to analyze the litigation trends and ensuing compensatory damages brought about by the use of episiotomy, in order to outline a set of cautionary rules meant to limit the scope of legreal aftermath for both doctors and health care facilities. The authors have set out to gain an insight into the controversial practice of episiotomy, in light of available research data and official positions of various scientific and medical associations, with a close focus on the legal and medical viability of the procedure itself. ⋯ This review showed that most episiotomy-related lawsuits stemmed from a routine use of that procedure, which is almost universally advised against, and without valid informed consent having been gained. Ultimately, authors have seen fit to underscore the need for patients potentially eligible for an episiotomy (selective episiotomy) to receive thorough and understandable information in a timely fashion including the necessity and the effectiveness of the procedure as well as the risks involved, so that a well-informed decision can be made based on factual data.