المؤلفون: Villar, Jose, Conti, Constanza P Soto, Gunier, Robert B, Ariff, Shabina, Craik, Rachel, Cavoretto, Paolo I, Rauch, Stephen, Gandino, Serena, Nieto, Ricardo, Winsey, Adele, Menis, Camilla, Rodriguez, Gabriel B, Savasi, Valeria, Tug, Niyazi, Deantoni, Sonia, Fabre, Marta, de Tejada, Begoña Martinez, Rodriguez-Sibaja, Maria Jose, Livio, Stefania, Napolitano, Raffaele, Maiz, Nerea, Sobrero, Helena, Peterson, Ashley, Deruelle, Philippe, Giudice, Carolina, Teji, Jagjit S, Casale, Roberto A, Salomon, Laurent J, Prefumo, Federico, Ismail, Leila Cheikh, Gravett, Michael G, Vale, Marynéa, Hernández, Valeria, Sentilhes, Loïc, Easter, Sarah R, Capelli, Carola, Marler, Emily, Cáceres, Daniela M, Crespo, Guadalupe Albornoz, Ernawati, Ernawati, Lipschuetz, Michal, Takahashi, Ken, Vecchiarelli, Carmen, Hubka, Teresa, Ikenoue, Satoru, Tavchioska, Gabriela, Bako, Babagana, Ayede, Adejumoke I, Eskenazi, Brenda, Thornton, Jim G, Bhutta, Zulfiqar A, Kennedy, Stephen H, Papageorghiou, Aris T, Consortium, INTERCOVID-2022 International

المصدر: The Lancet. 401(10375)

مصطلحات موضوعية: Prevention, Pediatric, Lung, Clinical Research, Immunization, Clinical Trials and Supportive Activities, Vaccine Related, 6.1 Pharmaceuticals, Evaluation of treatments and therapeutic interventions, Reproductive health and childbirth, Good Health and Well Being, Pregnancy, Infant, Newborn, Humans, Female, Male, Pregnancy Outcome, Vaccine Efficacy, COVID-19, SARS-CoV-2, COVID-19 Testing, Prospective Studies, Mothers, INTERCOVID-2022 International Consortium, Medical and Health Sciences, General & Internal Medicine

الوصف: BackgroundIn 2021, we showed an increased risk associated with COVID-19 in pregnancy. Since then, the SARS-CoV-2 virus has undergone genetic mutations. We aimed to examine the effects on maternal and perinatal outcomes of COVID-19 during pregnancy, and evaluate vaccine effectiveness, when omicron (B.1.1.529) was the variant of concern.MethodsINTERCOVID-2022 is a large, prospective, observational study, involving 41 hospitals across 18 countries. Each woman with real-time PCR or rapid test, laboratory-confirmed COVID-19 in pregnancy was compared with two unmatched women without a COVID-19 diagnosis who were recruited concomitantly and consecutively in pregnancy or at delivery. Mother and neonate dyads were followed until hospital discharge. Primary outcomes were maternal morbidity and mortality index (MMMI), severe neonatal morbidity index (SNMI), and severe perinatal morbidity and mortality index (SPMMI). Vaccine effectiveness was estimated, adjusted by maternal risk profile.FindingsWe enrolled 4618 pregnant women from Nov 27, 2021 (the day after WHO declared omicron a variant of concern), to June 30, 2022: 1545 (33%) women had a COVID-19 diagnosis (median gestation 36·7 weeks [IQR 29·0-38·9]) and 3073 (67%) women, with similar demographic characteristics, did not have a COVID-19 diagnosis. Overall, women with a diagnosis had an increased risk for MMMI (relative risk [RR] 1·16 [95% CI 1·03-1·31]) and SPMMI (RR 1·21 [95% CI 1·00-1·46]). Women with a diagnosis, compared with those without a diagnosis, also had increased risks of SNMI (RR 1·23 [95% CI 0·88-1·71]), although the lower bounds of the 95% CI crossed unity. Unvaccinated women with a COVID-19 diagnosis had a greater risk of MMMI (RR 1·36 [95% CI 1·12-1·65]). Severe COVID-19 symptoms in the total sample increased the risk of severe maternal complications (RR 2·51 [95% CI 1·84-3·43]), perinatal complications (RR 1·84 [95% CI 1·02-3·34]), and referral, intensive care unit (ICU) admission, or death (RR 11·83 [95% CI 6·67-20·97]). Severe COVID-19 symptoms in unvaccinated women increased the risk of MMMI (RR 2·88 [95% CI 2·02-4·12]) and referral, ICU admission, or death (RR 20·82 [95% CI 10·44-41·54]). 2886 (63%) of 4618 total participants had at least a single dose of any vaccine, and 2476 (54%) of 4618 had either complete or booster doses. Vaccine effectiveness (all vaccines combined) for severe complications of COVID-19 for all women with a complete regimen was 48% (95% CI 22-65) and 76% (47-89) after a booster dose. For women with a COVID-19 diagnosis, vaccine effectiveness of all vaccines combined for women with a complete regimen was 74% (95% CI 48-87) and 91% (65-98) after a booster dose.InterpretationCOVID-19 in pregnancy, during the first 6 months of omicron as the variant of concern, was associated with increased risk of severe maternal morbidity and mortality, especially among symptomatic and unvaccinated women. Women with complete or boosted vaccine doses had reduced risk for severe symptoms, complications, and death. Vaccination coverage among pregnant women remains a priority.FundingNone.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/42h0p5g9Test

المؤلفون: Giuliani, Francesca, Oros, Daniel, Gunier, Robert B, Deantoni, Sonia, Rauch, Stephen, Casale, Roberto, Nieto, Ricardo, Bertino, Enrico, Rego, Albertina, Menis, Camilla, Gravett, Michael G, Candiani, Massimo, Deruelle, Philippe, García-May, Perla K, Mhatre, Mohak, Usman, Mustapha Ado, Abd-Elsalam, Sherief, Etuk, Saturday, Napolitano, Raffaele, Liu, Becky, Prefumo, Federico, Savasi, Valeria, Do Vale, Marynéa Silva, Baafi, Eric, Ariff, Shabina, Maiz, Nerea, Aminu, Muhammad Baffah, Cardona-Perez, Jorge Arturo, Craik, Rachel, Tavchioska, Gabriela, Bako, Babagana, Benski, Caroline, Hassan-Hanga, Fatimah, Savorani, Mónica, Sentilhes, Loïc, Carola Capelli, Maria, Takahashi, Ken, Vecchiarelli, Carmen, Ikenoue, Satoru, Thiruvengadam, Ramachandran, Soto Conti, Constanza P, Cetin, Irene, Nachinab, Vincent Bizor, Ernawati, Ernawati, Duro, Eduardo A, Kholin, Alexey, Teji, Jagjit Singh, Easter, Sarah Rae, Salomon, Laurent J, Ayede, Adejumoke Idowu, Cerbo, Rosa Maria, Agyeman-Duah, Josephine, Roggero, Paola, Eskenazi, Brenda, Langer, Ana, Bhutta, Zulfiqar A, Kennedy, Stephen H, Papageorghiou, Aris T, Villar, Jose

المصدر: American journal of obstetrics and gynecology. 227(3)

مصطلحات موضوعية: Humans, Pregnancy Complications, Infectious, Pregnancy Complications, Premature Birth, Prenatal Exposure Delayed Effects, Pregnancy Outcome, Perinatal Care, Cohort Studies, Pregnancy, Child, Infant, Newborn, Female, Infectious Disease Transmission, Vertical, COVID-19, COVID-19 Testing, SARS-CoV-2, SARS-CoV-2 exposure, birthweight, breastfeeding, cesarean delivery, cohort, feeding problems, hospital stay, infections, intrauterine growth restriction, morbidity, mortality, multicenter study, neonatal intensive care unit admission, neonatal outcomes, neonate, neurologic outcome, newborn, perinatal practices, preeclampsia, pregnancy, preterm birth, respiratory support, respiratory symptoms, risk ratio, rooming-in, skin-to-skin, small for gestational age, Pediatric, Prevention, Clinical Research, Pediatric Research Initiative, Perinatal Period - Conditions Originating in Perinatal Period, Preterm, Low Birth Weight and Health of the Newborn, Conditions Affecting the Embryonic and Fetal Periods, Infant Mortality, Contraception/Reproduction, Reproductive health and childbirth, Good Health and Well Being, Paediatrics and Reproductive Medicine, Obstetrics & Reproductive Medicine

الوصف: BackgroundThe effect of COVID-19 in pregnancy on maternal outcomes and its association with preeclampsia and gestational diabetes mellitus have been reported; however, a detailed understanding of the effects of maternal positivity, delivery mode, and perinatal practices on fetal and neonatal outcomes is urgently needed.ObjectiveTo evaluate the impact of COVID-19 on fetal and neonatal outcomes and the role of mode of delivery, breastfeeding, and early neonatal care practices on the risk of mother-to-child transmission.Study designIn this cohort study that took place from March 2020 to March 2021, involving 43 institutions in 18 countries, 2 unmatched, consecutive, unexposed women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge. COVID-19 in pregnancy was determined by laboratory confirmation and/or radiological pulmonary findings or ≥2 predefined COVID-19 symptoms. The outcome measures were indices of neonatal and perinatal morbidity and mortality, neonatal positivity and its correlation with mode of delivery, breastfeeding, and hospital neonatal care practices.ResultsA total of 586 neonates born to women with COVID-19 diagnosis and 1535 neonates born to women without COVID-19 diagnosis were enrolled. Women with COVID-19 diagnosis had a higher rate of cesarean delivery (52.8% vs 38.5% for those without COVID-19 diagnosis, P14 days). Among neonates born to mothers with COVID-19 diagnosis, birth via cesarean delivery was a risk factor for testing positive for COVID-19 (odds ratio, 2.4; 95% confidence interval, 1.2-4.7), even when severity of maternal conditions was considered and after multivariable logistic analysis. In the subgroup of neonates born to women with COVID-19 diagnosis, the outcomes worsened when the neonate also tested positive, with higher rates of neonatal intensive care unit admission, fever, gastrointestinal and respiratory symptoms, and death, even after adjusting for prematurity. Breastfeeding by mothers with COVID-19 diagnosis and hospital neonatal care practices, including immediate skin-to-skin contact and rooming-in, were not associated with an increased risk of newborn positivity.ConclusionIn this multinational cohort study, COVID-19 in pregnancy was associated with increased maternal and neonatal complications. Cesarean delivery was significantly associated with newborn COVID-19 diagnosis. Vaginal delivery should be considered the safest mode of delivery if obstetrical and health conditions allow it. Mother-to-child skin-to-skin contact, rooming-in, and direct breastfeeding were not risk factors for newborn COVID-19 diagnosis, thus well-established best practices can be continued among women with COVID-19 diagnosis.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/5z02g3f7Test

المؤلفون: Eskenazi, Brenda, Rauch, Stephen, Iurlaro, Enrico, Gunier, Robert B, Rego, Albertina, Gravett, Michael G, Cavoretto, Paolo Ivo, Deruelle, Philippe, García-May, Perla K, Mhatre, Mohak, Usman, Mustapha Ado, Elbahnasawy, Mohamed, Etuk, Saturday, Napolitano, Raffaele, Deantoni, Sonia, Liu, Becky, Prefumo, Federico, Savasi, Valeria, Marques, Patrícia F, Baafi, Eric, Zainab, Ghulam, Nieto, Ricardo, Serrano, Berta, Aminu, Muhammad Baffah, Cardona-Perez, Jorge Arturo, Craik, Rachel, Winsey, Adele, Tavchioska, Gabriela, Bako, Babagana, Oros, Daniel, Benski, Caroline, Galadanci, Hadiza, Savorani, Mónica, Oberto, Manuela, Sentilhes, Loïc, Risso, Milagros, Takahashi, Ken, Vecciarelli, Carmen, Ikenoue, Satoru, Pandey, Anil K, Soto Conti, Constanza P, Cetin, Irene, Nachinab, Vincent Bizor, Ernawati, Ernawati, Duro, Eduardo A, Kholin, Alexey, Firlit, Michelle L, Easter, Sarah Rae, Sichitiu, Joanna, John-Akinola, Yetunde, Casale, Roberto, Cena, Hellas, Agyeman-Duah, Josephine, Roggero, Paola, Langer, Ana, Bhutta, Zulfiqar A, Kennedy, Stephen H, Villar, Jose, Papageorghiou, Aris T

المصدر: American Journal of Obstetrics and Gynecology. 227(1)

مصطلحات موضوعية: Reproductive Medicine, Biomedical and Clinical Sciences, Clinical Research, Nutrition, Diabetes, Prevention, Obesity, Reproductive health and childbirth, Metabolic and endocrine, Good Health and Well Being, Adiposity, Adolescent, Adult, Body Mass Index, COVID-19, COVID-19 Testing, Diabetes Mellitus, Type 1, Diabetes, Gestational, Female, Humans, Insulin, Obesity, Maternal, Overweight, Pregnancy, Pregnancy Outcome, body mass index, diabetes mellitus, gestational diabetes mellitus, obesity, overweight, pregnancy, SARS-CoV-2, Paediatrics and Reproductive Medicine, Obstetrics & Reproductive Medicine, Reproductive medicine

الوصف: BackgroundAmong nonpregnant individuals, diabetes mellitus and high body mass index increase the risk of COVID-19 and its severity.ObjectiveThis study aimed to determine whether diabetes mellitus and high body mass index are risk factors for COVID-19 in pregnancy and whether gestational diabetes mellitus is associated with COVID-19 diagnosis.Study designINTERCOVID was a multinational study conducted between March 2020 and February 2021 in 43 institutions from 18 countries, enrolling 2184 pregnant women aged ≥18 years; a total of 2071 women were included in the analyses. For each woman diagnosed with COVID-19, 2 nondiagnosed women delivering or initiating antenatal care at the same institution were also enrolled. The main exposures were preexisting diabetes mellitus, high body mass index (overweight or obesity was defined as a body mass index ≥25 kg/m2), and gestational diabetes mellitus in pregnancy. The main outcome was a confirmed diagnosis of COVID-19 based on a real-time polymerase chain reaction test, antigen test, antibody test, radiological pulmonary findings, or ≥2 predefined COVID-19 symptoms at any time during pregnancy or delivery. Relationships of exposures and COVID-19 diagnosis were assessed using generalized linear models with a Poisson distribution and log link function, with robust standard errors to account for model misspecification. Furthermore, we conducted sensitivity analyses: (1) restricted to those with a real-time polymerase chain reaction test or an antigen test in the last week of pregnancy, (2) restricted to those with a real-time polymerase chain reaction test or an antigen test during the entire pregnancy, (3) generating values for missing data using multiple imputation, and (4) analyses controlling for month of enrollment. In addition, among women who were diagnosed with COVID-19, we examined whether having gestational diabetes mellitus, diabetes mellitus, or high body mass index increased the risk of having symptomatic vs asymptomatic COVID-19.ResultsCOVID-19 was associated with preexisting diabetes mellitus (risk ratio, 1.94; 95% confidence interval, 1.55-2.42), overweight or obesity (risk ratio, 1.20; 95% confidence interval, 1.06-1.37), and gestational diabetes mellitus (risk ratio, 1.21; 95% confidence interval, 0.99-1.46). The gestational diabetes mellitus association was specifically among women requiring insulin, whether they were of normal weight (risk ratio, 1.79; 95% confidence interval, 1.06-3.01) or overweight or obese (risk ratio, 1.77; 95% confidence interval, 1.28-2.45). A somewhat stronger association with COVID-19 diagnosis was observed among women with preexisting diabetes mellitus, whether they were of normal weight (risk ratio, 1.93; 95% confidence interval, 1.18-3.17) or overweight or obese (risk ratio, 2.32; 95% confidence interval, 1.82-2.97). When the sample was restricted to those with a real-time polymerase chain reaction test or an antigen test in the week before delivery or during the entire pregnancy, including missing variables using imputation or controlling for month of enrollment, the observed associations were comparable.ConclusionDiabetes mellitus and overweight or obesity were risk factors for COVID-19 diagnosis in pregnancy, and insulin-dependent gestational diabetes mellitus was associated with the disease. Therefore, it is essential that women with these comorbidities are vaccinated.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/2f21k5n2Test

المؤلفون: Papageorghiou, Aris T, Deruelle, Philippe, Gunier, Robert B, Rauch, Stephen, García-May, Perla K, Mhatre, Mohak, Usman, Mustapha Ado, Abd-Elsalam, Sherief, Etuk, Saturday, Simmons, Lavone E, Napolitano, Raffaele, Deantoni, Sonia, Liu, Becky, Prefumo, Federico, Savasi, Valeria, do Vale, Marynéa Silva, Baafi, Eric, Zainab, Ghulam, Nieto, Ricardo, Maiz, Nerea, Aminu, Muhammad Baffah, Cardona-Perez, Jorge Arturo, Craik, Rachel, Winsey, Adele, Tavchioska, Gabriela, Bako, Babagana, Oros, Daniel, Rego, Albertina, Benski, Anne Caroline, Hassan-Hanga, Fatimah, Savorani, Mónica, Giuliani, Francesca, Sentilhes, Loïc, Risso, Milagros, Takahashi, Ken, Vecchiarelli, Carmen, Ikenoue, Satoru, Thiruvengadam, Ramachandran, Soto Conti, Constanza P, Ferrazzi, Enrico, Cetin, Irene, Nachinab, Vincent Bizor, Ernawati, Ernawati, Duro, Eduardo A, Kholin, Alexey, Firlit, Michelle L, Easter, Sarah Rae, Sichitiu, Joanna, Bowale, Abimbola, Casale, Roberto, Cerbo, Rosa Maria, Cavoretto, Paolo Ivo, Eskenazi, Brenda, Thornton, Jim G, Bhutta, Zulfiqar A, Kennedy, Stephen H, Villar, José

المصدر: American journal of obstetrics and gynecology. 225(3)

مصطلحات موضوعية: Humans, Pregnancy Complications, Hypertension, Pregnancy-Induced, Pre-Eclampsia, Premature Birth, Pregnancy Outcome, Risk Factors, Longitudinal Studies, Prospective Studies, Pregnancy, Adult, Female, COVID-19, SARS-CoV-2, SARS-CoV 2, aspirin, cohort, gestational hypertension, hypertension, hypertensive disorders in pregnancy, infection, morbidity, mortality, obesity, overweight, preeclampsia, pregnancy, preterm birth, proteinuria, relative risk, renal disease, risk ratio, small for gestational age, Cardiovascular, Perinatal Period - Conditions Originating in Perinatal Period, Contraception/Reproduction, Clinical Research, Preterm, Low Birth Weight and Health of the Newborn, Infant Mortality, Hypertension, Pediatric, Reproductive health and childbirth, Good Health and Well Being, Paediatrics and Reproductive Medicine, Obstetrics & Reproductive Medicine

الوصف: BackgroundIt is unclear whether the suggested link between COVID-19 during pregnancy and preeclampsia is an independent association or if these are caused by common risk factors.ObjectiveThis study aimed to quantify any independent association between COVID-19 during pregnancy and preeclampsia and to determine the effect of these variables on maternal and neonatal morbidity and mortality.Study designThis was a large, longitudinal, prospective, unmatched diagnosed and not-diagnosed observational study assessing the effect of COVID-19 during pregnancy on mothers and neonates. Two consecutive not-diagnosed women were concomitantly enrolled immediately after each diagnosed woman was identified, at any stage during pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed until hospital discharge using the standardized INTERGROWTH-21st protocols and electronic data management system. A total of 43 institutions in 18 countries contributed to the study sample. The independent association between the 2 entities was quantified with the risk factors known to be associated with preeclampsia analyzed in each group. The outcomes were compared among women with COVID-19 alone, preeclampsia alone, both conditions, and those without either of the 2 conditions.ResultsWe enrolled 2184 pregnant women; of these, 725 (33.2%) were enrolled in the COVID-19 diagnosed and 1459 (66.8%) in the COVID-19 not-diagnosed groups. Of these women, 123 had preeclampsia of which 59 of 725 (8.1%) were in the COVID-19 diagnosed group and 64 of 1459 (4.4%) were in the not-diagnosed group (risk ratio, 1.86; 95% confidence interval, 1.32-2.61). After adjustment for sociodemographic factors and conditions associated with both COVID-19 and preeclampsia, the risk ratio for preeclampsia remained significant among all women (risk ratio, 1.77; 95% confidence interval, 1.25-2.52) and nulliparous women specifically (risk ratio, 1.89; 95% confidence interval, 1.17-3.05). There was a trend but no statistical significance among parous women (risk ratio, 1.64; 95% confidence interval, 0.99-2.73). The risk ratio for preterm birth for all women diagnosed with COVID-19 and preeclampsia was 4.05 (95% confidence interval, 2.99-5.49) and 6.26 (95% confidence interval, 4.35-9.00) for nulliparous women. Compared with women with neither condition diagnosed, the composite adverse perinatal outcome showed a stepwise increase in the risk ratio for COVID-19 without preeclampsia, preeclampsia without COVID-19, and COVID-19 with preeclampsia (risk ratio, 2.16; 95% confidence interval, 1.63-2.86; risk ratio, 2.53; 95% confidence interval, 1.44-4.45; and risk ratio, 2.84; 95% confidence interval, 1.67-4.82, respectively). Similar findings were found for the composite adverse maternal outcome with risk ratios of 1.76 (95% confidence interval, 1.32-2.35), 2.07 (95% confidence interval, 1.20-3.57), and 2.77 (95% confidence interval, 1.66-4.63). The association between COVID-19 and gestational hypertension and the direction of the effects on preterm birth and adverse perinatal and maternal outcomes, were similar to preeclampsia, but confined to nulliparous women with lower risk ratios.ConclusionCOVID-19 during pregnancy is strongly associated with preeclampsia, especially among nulliparous women. This association is independent of any risk factors and preexisting conditions. COVID-19 severity does not seem to be a factor in this association. Both conditions are associated independently of and in an additive fashion with preterm birth, severe perinatal morbidity and mortality, and adverse maternal outcomes. Women with preeclampsia should be considered a particularly vulnerable group with regard to the risks posed by COVID-19.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/3wt0j4qqTest

المؤلفون: Häuser, Winfried, Morlion, Bart, Vowles, Kevin E., Bannister, Kirsty, Buchser, Eric, Casale, Roberto, Jean-François, Chenot, Chumbley, Gillian, Drewes, Asbjørn Mohr, Dom, Gert, Jutila, Liisa, O'Brien, Tony, Pogatzky-Zahn, Esther, Ragusa, Martin, Suarez–Serrano, Carmen, Tölle, Thomas, Krcevski–Škvarc, Nevenka

المصدر: Häuser , W , Morlion , B , Vowles , K E , Bannister , K , Buchser , E , Casale , R , Jean-François , C , Chumbley , G , Drewes , A M , Dom , G , Jutila , L , O'Brien , T , Pogatzky-Zahn , E , Ragusa , M , Suarez–Serrano , C , Tölle , T & Krcevski–Škvarc , N 2021 , ' European* clinical practice recommendations on opioids for chronic noncancer pain – Part 1 : Role of opioids in the management of chronic noncancer pain ' , European ....

مصطلحات موضوعية: Analgesics, Opioid/therapeutic use, Chronic Pain/drug therapy, Europe, Humans, North America, Opioid-Related Disorders

الوصف: Background: Opioid use for chronic non-cancer pain (CNCP) is complex. In the absence of pan-European guidance on this issue, a position paper was commissioned by the European Pain Federation (EFIC). Methods: The clinical practice recommendations were developed by eight scientific societies and one patient self-help organization under the coordination of EFIC. A systematic literature search in MEDLINE (up until January 2020) was performed. Two categories of guidance are given: Evidence-based recommendations (supported by evidence from systematic reviews of randomized controlled trials or of observational studies) and Good Clinical Practice (GCP) statements (supported either by indirect evidence or by case-series, case-control studies and clinical experience). The GRADE system was applied to move from evidence to recommendations. The recommendations and GCP statements were developed by a multiprofessional task force (including nursing, service users, physicians, physiotherapy and psychology) and formal multistep procedures to reach a set of consensus recommendations. The clinical practice recommendations were reviewed by five external reviewers from North America and Europe and were also posted for public comment. Results: The key clinical practice recommendations suggest: (a) first optimizing established non-pharmacological treatments and non-opioid analgesics and (b) considering opioid treatment if established non-pharmacological treatments or non-opioid analgesics are not effective and/or not tolerated and/or contraindicated. Evidence- and clinical consensus-based potential indications and contraindications for opioid treatment are presented. Eighteen GCP recommendations give guidance regarding clinical evaluation, as well as opioid treatment assessment, monitoring, continuation and discontinuation. Conclusions: Opioids remain a treatment option for some selected patients with CNCP under careful surveillance.

وصف الملف: application/pdf

العلاقة: https://vbn.aau.dk/da/publications/bd4df1e0-6269-40cb-a48c-1db6aec873ffTest

الإتاحة: https://doi.org/10.1002/ejp.1736Test
https://vbn.aau.dk/da/publications/bd4df1e0-6269-40cb-a48c-1db6aec873ffTest
https://vbn.aau.dk/ws/files/413502393/H_user_et_al._2021_European_clinical_practice_recommendations_on_opioids_for_chronic_noncancer_pain_Part_1.pdfTest
http://www.scopus.com/inward/record.url?scp=85101855782&partnerID=8YFLogxKTest

المؤلفون: Riedel, Rodrigo, Pérez-Pérez, Antonio, Carmona-Fernández, Antonio, Jaime, Mariana, Casale, Roberto, Dueñas, José Luis, Guadix, Pilar, Sánchez-Margalet, Víctor, Varone, Cecilia L, Maymó, Julieta L

مصطلحات موضوعية: Amnion, Carcinoma, Hepatocellular, Cell Cycle Checkpoints, Cell Proliferation, Culture Media, Conditioned, Cyclin D1, Female, Gene Expression Regulation, Neoplastic, Hep G2 Cells, Humans, Liver Neoplasms, MicroRNAs, Placenta, Pregnancy, Proto-Oncogene Proteins c-mdm2, Stem Cells, Tumor Suppressor Protein p53

الوصف: The placental stem cells have called the focus of attention for their therapeutic potential to treat different diseases, including cancer. There is plenty evidence about the antiproliferative, antiangiogenic and proapoptotic properties of the amniotic membrane. Liver cancer is the fifth cause of cancer in the world, with a poor prognosis and survival. Alternative treatments to radio- or chemotherapy have been searched. In this work we aimed to study the antiproliferative properties of the human amniotic membrane conditioned medium (AM-CM) in hepatocarcinoma cells. In addition, we have analyzed the regulation of pro and antiOncomiRs expression involved in hepatocarcinoma physiology. We have determined by 3H-thymidine incorporation assay that AM-CM inhibits DNA synthesis in HepG2 cells after 72 h of treatment. AM-CM pure or diluted at 50% and 25% also diminished HepG2 and HuH-7 cells viability and cell number. Furthermore, AM-CM induced cell cycle arrest in G2/M. When proliferation mechanisms were analyzed we found that AM-CM reduced the expression of both Cyclin D1 mRNA and protein. Nuclear expression of Ki-67 was also reduced. We observed that this CM was able to promote the expression of p53 and p21 mRNA and proteins, leading to cell growth arrest. Moreover, AM-CM induced an increase in nuclear p21 localization, observed by immunofluorescence. As p53 levels were increased, Mdm-2 expression was downregulated. Interestingly, HepG2 and HuH-7 cells treatment with AM-CM during 24 and 72 h produced an upregulation of antiOncomiRs 15a and 210, and a downregulation of proOncomiRs 206 and 145. We provide new evidence about the promising novel applications of human amniotic membrane in liver cancer.

وصف الملف: application/pdf

العلاقة: http://hdl.handle.net/10668/14576Test; PMC6775050; https://www.nature.com/articles/s41598-019-50648-5.pdfTest; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6775050/pdfTest

الإتاحة: https://doi.org/10.1038/s41598-019-50648-5Test
http://hdl.handle.net/10668/14576Test
https://www.nature.com/articles/s41598-019-50648-5.pdfTest
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6775050/pdfTest

المؤلفون: Atzeni, Fabiola, Casale, Roberto, Alciati, Alessandra, Masala, Ignazio Francesco, Batticciotto, Alberto, Talotta, Rossella, Gerardi, Maria Chiara, Salaffi, Fausto, Sarzi-Puttini, Piercarlo

المصدر: Clinical and experimental rheumatology. 37(1)

مصطلحات موضوعية: Oxygen, Hyperbaric Oxygenation, Fibromyalgia, Treatment Outcome, Humans, Prospective Studies, Quality of Life

الوصف: Fibromyalgia (FM) is a syndrome of unknown aetiology that is characterised by widespread musculoskeletal pain, fatigue and disordered sleep, and often associated with neuropsychiatric and cognitive symptoms. Current treatment options are only partially effective, but hyperbaric oxygen therapy (HBOT) seems to be capable of relieving some of the symptoms. The aim of this study was to evaluate the efficacy and safety of HBOT after fewer sessions than generally used, chosen on the basis of pre-clinical and clinical data showing its rapid and sustained antinociceptive effect.Patients with FM underwent HBOT (100% oxygen at 2.5 ata with air breaks) administered on three days per week for a total of twenty 90-minute sessions. Pain, fatigue, the quality of sleep, symptoms of anxiety and depression, and the patients' health-related quality of life were prospectively assessed before and after ten and twenty sessions.Twenty-eight of the 32 study patients completed the 20 HBOT sessions. Pain scores and the symptoms of anxiety (but not those of depression) significantly improved after both 10 and 20 sessions, whereas fatigue and FM symptom severity scores significantly improved only after 20 sessions. There was no significant change in the quality of sleep. The adverse effects were limited.These findings support the view that HBOT is an effective, rapid and safe means of treating various symptoms of FM.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=pmid_dedup__::a49ec500a089a009d309002a9bac6756Test
https://pubmed.ncbi.nlm.nih.gov/30747099Test

المؤلفون: Leone, Antonio, Dell'Atti, Claudia, Magarelli, Nicola, Colelli, Pamela, Casale, Roberto, Bonomo, Lorenzo

المساهمون: Leone, Antonio, Dell'Atti, Claudia, Magarelli, Nicola, Colelli, Pamela, Balanika, A, Casale, Roberto, Bonomo, Lorenzo

مصطلحات موضوعية: Magnetic Resonance Imaging, Adult, Aged, Diagnosis, Differential, Discitis, Female, Humans, Intervertebral Disc, Male, Middle Aged, Osteomyelitis, Predictive Value of Tests, Prognosis, Tomography, X-Ray Computed, Settore MED/36 - DIAGNOSTICA PER IMMAGINI E RADIOTERAPIA

الوصف: Spinal infections (pyogenic or non-pyogenic) are increasing in incidence and are a common cause of morbidity in high-risk patients (elderly, immunocompromised patients, diabetic patients, drug addicts, and patients with sickle-cell disease).

العلاقة: info:eu-repo/semantics/altIdentifier/pmid/22655479; info:eu-repo/semantics/altIdentifier/wos/WOS:000304183200003; volume:16 Suppl 2; issue:Aprile; firstpage:8; lastpage:19; numberofpages:12; issueyear:2012; journal:EUROPEAN REVIEW FOR MEDICAL AND PHARMACOLOGICAL SCIENCES; http://hdl.handle.net/10807/37693Test; info:eu-repo/semantics/altIdentifier/scopus/2-s2.0-84862690888

الإتاحة: http://hdl.handle.net/10807/37693Test

المؤلفون: Casale Roberto, Sarzi Puttini Piercarlo, Fabiola Atzeni, Dan Buskila, Rainoldi Alberto, GAZZONI, MARCO

المساهمون: Casale, Roberto, Sarzi Puttini, Piercarlo, Fabiola, Atzeni, Gazzoni, Marco, Dan, Buskila, Rainoldi, Alberto

مصطلحات موضوعية: Adult, Case-Control Studies, Central Nervous System, physiopathology, Electric Stimulation, Electromyography, Fatigue, etiology/physiopathology, Female, Fibromyalgia, complications/physiopathology, Humans, Middle Aged, Motor Neurons, Muscle Contraction, Muscle Fatigue, Muscle, Skeletal, innervation, Recruitment, Neurophysiological, Volition

الوصف: Fibromyalgia (FM) is characterised by diffuse musculoskeletal pain and stiffness at multiple sites, tender points in characteristic locations, and the frequent presence of symptoms such as fatigue. The aim of this study was to assess whether the myoelectrical manifestations of fatigue in patients affected by FM are central or peripheral in origin.Eight female patients aged 55.6 +/- 13.6 years (FM group) and eight healthy female volunteers aged 50.3 +/- 9.3 years (MCG) were studied by means of non-invasive surface electromyography (s-EMG) involving a linear array of 16 electrodes placed on the skin overlying the biceps brachii muscle, with muscle fatigue being evoked by means of voluntary and involuntary (electrically elicited) contractions. Maximal voluntary contractions (MVCs), motor unit action potential conduction velocity distributions (mean +/- SD and skewness), and the mean power frequency of the spectrum (MNF) were estimated in order to assess whether there were any significant differences between the two groups and contraction types.The motor pattern of recruitment during voluntary contractions was altered in the FM patients, who also showed fewer myoelectrical manifestations of fatigue (normalised conduction velocity rate of changes: -0.074 +/- 0.052\%/s in FM vs -0.196 +/- 0.133\%/s in MCG; normalised MNF rate of changes: -0.29 +/- 0.16\%/s in FM vs -0.66 +/- 0.34\%/s in MCG). Mean conduction velocity distribution and skewnesses values were higher (p < 0.01) in the FM group. There were no between-group differences in the results obtained from the electrically elicited contractions.The apparent paradox of fewer myoelectrical manifestations of fatigue in FM is the electrophysiological expression of muscle remodelling in terms of the prevalence of slow conducting fatigue-resistant type I fibres. As the only between-group differences concerned voluntary contractions, they are probably more related to central motor control failure than muscle membrane alterations, which suggests pathological muscle fibre ...

العلاقة: info:eu-repo/semantics/altIdentifier/pmid/19570214; info:eu-repo/semantics/altIdentifier/wos/WOS:000268671100001; volume:10; firstpage:78; numberofpages:9; journal:BMC MUSCULOSKELETAL DISORDERS; http://hdl.handle.net/11583/2573347Test; info:eu-repo/semantics/altIdentifier/scopus/2-s2.0-68149108449; http://dx.doi.org/10.1186/1471-2474-10-78Test

الإتاحة: https://doi.org/10.1186/1471-2474-10-78Test
http://hdl.handle.net/11583/2573347Test

المؤلفون: Guggino, G., Schinocca, C., Lo Pizzo, M., Di Liberto, D., Garbo, D., Raimondo, S., Alessandro, R., Brighina, F., Ruscitti, P., Giacomelli, R., Sireci, G., Triolo, G., Casale, R., Sarzi-Puttini, P., Dieli, F.

المساهمون: Guggino, Giuliana, Schinocca, Claudia, Lo Pizzo, Marianna, Di Liberto, Diana, Garbo, Domenico, Raimondo, Stefania, Alessandro, Riccardo, Brighina, Filippo, Ruscitti, Piero, Giacomelli, Roberto, Sireci, Guido, Triolo, Giovanni, Casale, Roberto, Sarzi-Puttini, Piercarlo, Dieli, Francesco

المصدر: Clinical and experimental rheumatology. 38(6)

مصطلحات موضوعية: Hyperbaric Oxygenation, Settore MED/16 - Reumatologia, Fibromyalgia, T1 helper, fibromyalgia, hyperbaric oxygen therapy, immune system, pain, fatigue, sleeping disorders, quality of life, Quality of Life, Cytokines, Humans, Th1 Cells, Sleep, Fatigue, CD4 Lymphocyte Count

الوصف: Hyperbaric oxygen therapy (HBOT) has been used as treatment for different clinical conditions, including fibromyalgia (FM). HBOT modulates brain activity, ameliorates chronic pain and modifies the ratio of immune cells. Clinical studies have provided evidence that FM is associated with immune system dysregulation. In the present study we aimed to evaluate the effect of HBOT on immune system and on the quality of life-style of FM patients.Patients with primary FM and controls were treated with HBOT. Physical, emotional and social assessment, quality of sleep, tender points, intensity score, WPI and symptom severity were evaluated before and after HBOT. Furthermore, a characterisation of CD4 T lymphocytes and their cytokine production was performed by flow cytometry. The expression of TNF-α, IFN-γ, IL-17, IL-9 and IL-22 was also assessed by RT-PCR. Finally, the serum levels of serotonin were evaluated by ELISA.Our results confirm the participation of immune system in the pathogenesis of FM and highlight the impact of HBOT treatment, with particular regard to the changes on proinflammatory cytokines production by CD4 T cells subsets.FM patients show a Th1 signature and the activation of this subset is modulated by HBOT.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=pmid_dedup__::5742fab3ee393d8874eabd58fece0bc4Test
https://pubmed.ncbi.nlm.nih.gov/30747094Test