#61
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Ïðî ýôôåêòèâíîñòü àñïèðèíà è åãî äîçèðîâêè â çàâèñèìîñòè îò âåñà ïàöèåíòà:
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#62
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Ïîâûøåííûé óðîâåíü ôàêòîðà 8 (FVIII) áîëåå 150% ÿâëÿåòñÿ ôàêòîðîì ðèñêà öåðåáðàëüíîãî âåíîçíîãî òðîìáîçà, ïðè÷åì ó ìóæ÷èí òàêàÿ àññîöèàöèÿ áîëåå âûðàæåíà: 23-êðàòíûé ðèñê ïî ñðàâíåíèþ ñ 15-êðàòíûì ó æåíùèí, èíòåðåñíî, ÷òî ðèñê òðîìáîçà ãëóáîêèõ âåí íèæíèõ êîíå÷íîñòåé ïîâûøåí âñåãî â ñðåäíåì â 6 ðàç ïðè öèôðàõ àêòèâíîñòè ôàêòîðà 8 áîëåå 150% ïî ñðàâíåíèþ ñ ìåíåå 100%, ïîäðîáíåå:
Elevated factor VIII increases the risk of cerebral venous thrombosis: a case-control study. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] â ïðåäûäóùåé ñòàòüå 2014 ã. èç Èíäèè ôàêòîð 8 áîëåå 170% àññîöèèðîâàëñÿ ñ 19-êðàòíûì ðèñêîì öåðåáðàëüíîãî âåíîçíîãî òðîìáîçà: Plasma factor VIII in non-puerperal cerebral venous thrombosis: a prospective case-control study. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#63
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öåðåáðàëüíûé âåíîçíûé òðîìáîç - ôàêòîðû ðèñêà è èõ êðàòíîå ðèñêîâîå ñîîòíîøåíèå:
Twenty non-genetic (n = 2314) and 33 genetic (n = 2117) studies up to January 2017 met the selection criteria. For non-genetic factors, CVT risk increased in the presence of glucocorticosteroid therapy by 18.3-fold (3.3-102.6), alcohol consumption 2.7-fold (1.8-3.9), infection 7.5-fold (2.6-21.6), surgery 9.6-fold (1.1-83.5), hypercholesterolaemia 2.4-fold (1.3-4.4), hyperhomocysteinaemia 3.1-fold (2.1-4.6), antiphospholipid antibodies 7.0-fold (2.1-23.6), autoimmune diseases 5.6-fold (2.3-13.6), anaemia 4.0-fold (2.1-7.9), malignancy 3.2-fold (1.4-7.1) and pregnancy/puerperium 11.4-fold (5.7-24.3). Smoking, hypertension and diabetes did not associate with CVT risk. For genetic factors, CVT risk increased in the presence of factor V Leiden (G1691A) by 2.5-fold (1.9-3.3), protein C deficiency 10.7-fold (3.1-37.7), protein S deficiency 5.7-fold (1.4-22.4), antithrombin deficiency 3.8-fold (1.0-13.8), prothrombin (G20210A) 5.5-fold (4.0-7.27) and TAFI gene variant (C1040T) 1.6-fold (1.0-2.4). [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#64
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Íàêîíåö- òî âûøåë äîëãîæäàííûé íåìåöêèé ãàéäëàéí ïî îòêðûòîìó îâàëüíîìó îêíó è êðèïòîãåííîìó èíñóëüòó.
Ðåêîìåíäîâàíî çàêðûòèå îî ïðè íàëè÷èè øóíòà ñïðàâà-íàëåâî, îò ñðåäíå - äî âûðàæåííîé ôîðìû ó ïàöèåíòîâ äî 60 ëåò. Äàííûå ðåêîìåíäàöèè îñíîâàíû íà àíàëèçå ðåçóëüòàòîâ ñòóäèé: REDUCE, CLOSE, RESPECT, DEFENSE-PFO. Ïîñòîïåðàòèâíî ðåêîìåíäîâàí ïðèåì àñïèðèí 100ìã + êëîïèäîãðåëü 75 ìã îäèí-òðè ìåñÿöà, çàòåì ìîíîòåðàïèÿ àñïèðèí èëè êëîïè 6-12 ìåñÿöåâ, ïðè àòåðîñêëåðîçå ïîæèçíåííî. Íà íåìöêîì ìîæíî ïî÷èòàòü òóò: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#65
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â êîíöå èþëÿ ïîõîæèå ïóáëèêàöèè â ñâîá. äîñòóïå â BMJ:
Patent foramen ovale closure, antiplatelet therapy or anticoagulation therapy alone for management of cryptogenic stroke? A clinical practice guideline. Kuijpers T, et al. BMJ. 2018 Jul 25;362:k2515 [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] --- Patent foramen ovale closure, antiplatelet therapy or anticoagulation in patients with patent foramen ovale and cryptogenic stroke: a systematic review and network meta-analysis incorporating complementary external evidence. Mir H, et al BMJ Open. 2018 Jul 25;8(7):e023761. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#66
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Ñåðèÿ ïóáëèêàöèé èç Àçèè î öåðåáðàëüíûõ èíôàðêòàõ/òðîìáîçàõ ó æåíùèí ñ àäåíîìèîçîì è ïîâûøåííûì óðîâíåì CA125:
Cerebral infarcts associated with adenomyosis among middle-aged women. Yamashiro K, Tanaka R, Nishioka K, Ueno Y, Shimura H, Okuma Y, Hattori N, Urabe T. J Stroke Cerebrovasc Dis. 2012 Nov;21(8):910.e1-5. Cerebral dural sinus thrombosis associated with adenomyosis: a case report. Nishioka K, Tanaka R, Tsutsumi S, Yamashiro K, Nakahara M, Shimura H, Hattori N, Urabe T. J Stroke Cerebrovasc Dis. 2014 Aug;23(7):1985-7. Multiple Cerebral Infarctions in a Patient with Adenomyosis on Hormone Replacement Therapy: A Case Report. Hijikata N, Sakamoto Y, Nito C, Matsumoto N, Abe A, Nogami A, Sato T, Hokama H, Okubo S, Kimura K. J Stroke Cerebrovasc Dis. 2016 Oct;25(10):e183-4. Recurrent multiple cerebral infarctions related to the progression of adenomyosis: a case report. Aso Y, Chikazawa R, Kimura Y, Kimura N, Matsubara E. BMC Neurol. 2018 Aug 21;18(1):119. Cerebral Infarcts by Nonbacterial Thrombotic Endocarditis Associated with Adenomyosis: A Case Report. Kim B, Kim SH, Kim T. J Stroke Cerebrovasc Dis. 2018 Mar;27(3):e50-e53. Nonbacterial Thrombotic Endocarditis Complicated by Cerebral Infarction in a Patient with Adenomyosis with High Serum CA125 Level; A Case Report. Uchino K, Shimizu T, Mizukami H, Isahaya K, Ogura H, Shinohara K, Hasegawa Y. J Stroke Cerebrovasc Dis. 2018 Mar;27(3):e42-e45. Low-dose gonadotropin-releasing hormone agonist therapy (draw-back therapy) for successful long-term management of adenomyosis associated with cerebral venous and sinus thrombosis from low-dose oral contraceptive use. Matsushima T, Akira S, Asakura H, Takeshita T. Clin Exp Obstet Gynecol. 2017;44(1):143-145. Dysfunctional coagulation and fibrinolysis systems due to adenomyosis is a possible cause of thrombosis and menorrhagia. Yamanaka A, Kimura F, Yoshida T, Kita N, Takahashi K, Kushima R, Murakmai T. Eur J Obstet Gynecol Reprod Biol. 2016 Sep;204:99-103.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#67
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Äîëãîñðî÷íûé ïðîãíîç ó ïàöèåíòîâ ñ öåðåáðî-âåíîçíûì òðîìáîçîì - àíåìèÿ áûëà îáíàðóæåíà ó 1/3 ïàöèåíòîâ. Òÿæåëàÿ èëè ìèêðîöèòàðíàÿ àíåìèÿ àññîöèèðîâàëàñü ñ ñàìûì âûñîêèì ðèñêîì ñìåðòíîñòè ~10õ:
A total of 238 CVT patients were included, among whom 73 patients (30.7%) were diagnosed with anemia. Subgroup analysis showed that severe anemia was independently associated with mRS of 3-6 (OR = 8.8; 95% CI, 1.9-40.8; P = 0.005) and mortality (OR = 9.8; 95% CI, 1.8-53.3; P = 0.01). Similarly, microcytic anemia increased the risk of mRS of 3-6 (OR = 4.6; 95% CI, 1.5-14.5; P = 0.008) and mortality (OR = 9.7; 95% CI, 2.6-35.9; P = 0.001). --- Neurocrit Care. 2018 Jul 9. Long-Term Outcomes in Patients with Anemia And Cerebral Venous Thrombosis. Liu K, è ñîàâò.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#68
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Íå ïîíÿë RECOMMENDATION 1 .
Ann Intern Med. 2017 Apr 4;166(7):514-530. doi: 10.7326/M16-2367. Epub 2017 Feb 14. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. RECOMMENDATION 1: Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation). RECOMMENDATION 2: For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation). RECOMMENDATION 3: In patients with chronic low back pain who have had an inadequate response to nonpharmacologic therapy, clinicians and patients should consider pharmacologic treatment with nonsteroidal anti-inflammatory drugs as first-line therapy, or tramadol or duloxetine as second-line therapy. Clinicians should only consider opioids as an option in patients who have failed the aforementioned treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients. (Grade: weak recommendation, moderate-quality evidence). Âîëüíî-óòðèðîâàííî ïîëó÷àåòñÿ, ÷òî – « Ñ îñòðîé áîëüþ âñå ðàâíî áóäåò ëó÷øå íåçàâèñèìî îò ëå÷åíèÿ, ïîýòîìó âûáèðàéòå íåôàðìàêîëîãè÷åñêîå ëå÷åíèå..» . Ýòî êàê? Èëè ÿ êàêèå-òî òîíêîñòè ïåðåâîäà íå óëîâèë? Íàñ÷åò ðåêîìåíäàöèé 2 è 3, åñòåñòâåííî, âîïðîñîâ íèêàêèõ.
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Êîãäà çíàåøü ïî÷åìó íåëüçÿ, òî óæå ìîæíî (ñ) Ñ óâàæåíèåì, Ãóñåéíîâ Òèìóð Þñóôîâè÷ Ñàéò dr-timur.ru |
#69
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Ìåíÿ òîæå ñíà÷àëà íåìíîãî ñìóùàëà ýòà ðåêîìåíäàöèÿ. ß ýòî ïîíèìàþ òàê: åñëè áîëü ë¸ãêàÿ/óìåðåííàÿ, òî, ïî âîçìîæíîñòè, ñëåäóåò âûáðàòü íåôàðìàêîëîãè÷åñêîå ëå÷åíèå, åñëè æå óìåðåííàÿ áîëü íå ðåàãèðóåò íà íåôàðìàêîëîãè÷åñêîå ëå÷åíèå èëè æå èçíà÷àëüíî ñèëüíàÿ (ïî ïîâîäó ïîñëåäíåãî - èç òåêñòà ïðÿìûõ óêàçàíèé íåò, íî, âèäèìî, îíè ðåøèëè, ÷òî ýòî ïî óìîë÷àíèþ) - âûáðàòü ìåäèêàìåíòû. Íó à ôàðìàêîòåðàïèÿ, âðîäå, îòäàë¸ííûå ïðîãíîçû íå óëó÷øàåò, ýòî ÷èñòî ñèìïòîìàòè÷åñêîå ëå÷åíèå (âî âñÿêîì ñëó÷àå, äîêàçàòåëüñòâ ïîêà íåò).
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#71
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òàêîå ïîäîéäåò?
Clinical experience with transcutaneous supraorbital nerve stimulation in patients with refractory migraine or with migraine and intolerance to topiramate: a prospective exploratory clinical study [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#72
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Íèêîëàé, à èíòåðåñ êóïèðîâàòü ïðèñòóï èëè ïðîôèëàêòèêà?
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Ñ óâàæåíèåì, Àíàñòàñèÿ Âàëåðüåâíà. Ìîé Instagram àêêàóíò @asarycheva |
#73
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29 èþíÿ íà÷íåòñÿ 14-é Êîíãðåññ Åâðîïåéñêîé ôåäåðàöèè ãîëîâíîé áîëè (EHF)
Âïåðâûå îíëàéí. Ñ áåñïëàòíîé ðåãèñòðàöèåé. Ïðè æåëàíèè ìîæíî è ïîãîâîðèòü Ðåãèñòðàöèÿ: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Ïîäðîáíîñòè íà ñàéòå: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] P.S. Ïî ññûëêå íà ðåãèñòðàöèþ ìîé àíòèâèðóñ ïðåäóïðåäèë î âèðóñå. Ñîìíåâàþñü, ÷òî òàêîå âîçìîæíî íà äîñòîéíîì ñàéòå.  îáùåì çàðåãèñòðèðîâàëñÿ. Ïîòîì ïðîâåðÿë íà âèðóñû. Íè÷åãî íàéäåíî íå áûëî.
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Êîãäà çíàåøü ïî÷åìó íåëüçÿ, òî óæå ìîæíî (ñ) Ñ óâàæåíèåì, Ãóñåéíîâ Òèìóð Þñóôîâè÷ Ñàéò dr-timur.ru |
#74
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Ìîæåò áûòü ïîðàæåí ïî íåâåäåíèþ. Íî ñîâåòóþ çàãëÿíóòü íà 14-é Êîíãðåññ Åâðîïåéñêîé ôåäåðàöèè ãîëîâíîé áîëè (EHF) äàæå ñ òî÷êè çðåíèÿ ïðåäñòàâëåíèÿ, ÷òî áóäåò â ñêîðîì áóäóùåì îáû÷íûì. Òðåõìåðíûé çàë ñ òî÷êàìè èíôîðìàöèè,ñòåíäîâûå äîêëàäû, ðåêëàìû ëåêàðñòâ, ïðîäàæè ... Âûõîäû â ïîìåùåíèÿ ãäå èäóò ëåêöèè ïðî ïðîãðàììå êîíãðåññà, ... Ëåêòîðàì çàäàþò âîïðîñû, îíè îòâå÷àþò... Ëåêòîðû óäîáíî ñèäÿò çà ñâîèìè äîìàøíèìè ñòîëàìè..
Äëÿ ìåíÿ èç ïðîøëîãî âåêà ýòî ôàíòàñòèêà
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Êîãäà çíàåøü ïî÷åìó íåëüçÿ, òî óæå ìîæíî (ñ) Ñ óâàæåíèåì, Ãóñåéíîâ Òèìóð Þñóôîâè÷ Ñàéò dr-timur.ru |
#75
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Ðåêîìåíäàöèè AHA|ASA ïî âòîðè÷íîé ïðîôèëàêòèêå èíñóëüòà 2021 (pdf)
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Ôèëèïïîâ Ïàâåë Ãåííàäüåâè÷. |