Acs, Nándor*
Dotaz
Zobrazit nápovědu
Severe post-partum hemorrhage (PPH) is a major cause of maternal mortality worldwide. Recombinant activated factor VII (rFVIIa) has recently been approved by the European Medicines Agency for the treatment of severe PPH if uterotonics fail to achieve hemostasis. Although large randomized controlled trials are lacking, accumulated evidence from smaller studies and international registries supports the efficacy of rFVIIa alongside extended standard treatment to control severe PPH. Because rFVIIa neither substitutes the activity of a missing coagulation factor nor bypasses a coagulation defect in this population, it is not immediately evident how it exerts its beneficial effect. Here, we discuss possible mechanistic explanations for the efficacy of rFVIIa and the published evidence in patients with severe PPH. Recombinant FVIIa may not primarily increase systemic thrombin generation, but may promote local thrombin generation through binding to activated platelets at the site of vascular wall injury. This explanation may also address safety concerns that have been raised over the administration of a procoagulant molecule in a background of increased thromboembolic risk due to both pregnancy-related hemostatic changes and the hemorrhagic state. However, the available safety data for this and other indications are reassuring and the rates of thromboembolic events do not appear to be increased in women with severe PPH treated with rFVIIa. We recommend that the administration of rFVIIa be considered before dilutional coagulopathy develops and used to support the current standard treatment in certain patients with severe PPH.
- Publikační typ
- časopisecké články MeSH
PURPOSE: This study aimed to determine the effects of a 2-yr-long maintenance training (MT) exergaming and detraining (DT) on clinical-motor symptoms in subacute ischemic patients with stroke (PwST). The hypothesis was that MT motor rehabilitation program would further increase the effects of the initial rehabilitation. METHODS: After high-intensity and high-frequency exergaming twice or once a day, 5 times per week for 5 wk (EX2: 50 sessions; EX1: 25 sessions, results reported previously), 558 PwST were randomized to EX2-MT, EX2-DT, EX1-MT, and EX1-DT. MT exergaming consisted of once a day, 3 times per week for 2 yr, and DT did not train. Outcomes were measured at 6, 12, 18, and 24 months. The data were analyzed using longitudinal linear mixed-effects models and general linear hypotheses testing. RESULTS: Modified Rankin Score (primary outcome), body mass, Mini-Mental State Examination score, Beck Depression Inventory, measures of quality of life, Berg Balance Scale, 6-min walk test, and four measures of center of pressure path tended to retain the initial rehabilitation-induced gains in the MT patients in selected outcomes (especially walking capacity). The scores tended to mildly worsen after DT, partially supporting the hypothesis. CONCLUSIONS: MT successfully maintained, but only in selected variables did it further increase the initial exergaming rehabilitation-induced robust improvements. DT modestly reduced the initial exergaming rehabilitation-induced improvements. MT programs might be needed after initial stroke rehabilitation to reduce subsequent losses of quality of life and further improve clinical-motor symptoms.
- MeSH
- cévní mozková příhoda * MeSH
- ischemická cévní mozková příhoda * MeSH
- kvalita života MeSH
- lidé MeSH
- rehabilitace po cévní mozkové příhodě * metody MeSH
- terapie cvičením metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
Voluntary isolation is one of the most effective methods for individuals to help prevent the transmission of diseases such as COVID-19. Understanding why people leave their homes when advised not to do so and identifying what contextual factors predict this non-compliant behavior is essential for policymakers and public health officials. To provide insight on these factors, we collected data from 42,169 individuals across 16 countries. Participants responded to items inquiring about their socio-cultural environment, such as the adherence of fellow citizens, as well as their mental states, such as their level of loneliness and boredom. We trained random forest models to predict whether someone had left their home during a one week period during which they were asked to voluntarily isolate themselves. The analyses indicated that overall, an increase in the feeling of being caged leads to an increased probability of leaving home. In addition, an increased feeling of responsibility and an increased fear of getting infected decreased the probability of leaving home. The models predicted compliance behavior with between 54% and 91% accuracy within each country's sample. In addition, we modeled factors leading to risky behavior in the pandemic context. We observed an increased probability of visiting risky places as both the anticipated number of people and the importance of the activity increased. Conversely, the probability of visiting risky places increased as the perceived putative effectiveness of social distancing decreased. The variance explained in our models predicting risk ranged from < .01 to .54 by country. Together, our findings can inform behavioral interventions to increase adherence to lockdown recommendations in pandemic conditions.
- MeSH
- COVID-19 * epidemiologie prevence a kontrola MeSH
- fyzický odstup MeSH
- kontrola infekčních nemocí MeSH
- lidé MeSH
- pandemie MeSH
- strojové učení MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Purpose: The contraceptive pill is an effective and safe method of preventing pregnancy. The progestins used for contraception either are components of a combined hormonal contraceptive (tablets, patches or vaginal rings) or are used alone in progestin-only formulations. Progestin-only contraceptives are available as daily oral preparations, subcutaneous or intramuscular injectables (every 1-3 months), subdermal implants (every 3-5 years) and intrauterine systems (every 3-5 years). Long-acting progestins are highly effective in typical use and have a very low risk profile and few contraindications.Material and Methods: A new progestin-only, oestrogen-free contraceptive, drospirenone, in a dosage of 4 mg/day in a 24/4 regimen, has received regulatory approval in the USA and the EU. The molecule has antigonadotropic, antimineralocorticoid, antiestrogenic and antiandrogenic properties.Results: The regimen was chosen to improve the bleeding profile; maintain plasma oestradiol levels at those of the early follicular phase, to avoid hypoestrogenism; and preserve efficacy even with a missed pill, as drospirenone has a half-life of 30-34 h.Conclusions: Clinical studies have shown good efficacy, very low cardiovascular side effects and a favourable bleeding pattern, as well as maintenance of ovulation inhibition after scheduled 24 h delays in pill intake.
Objective: To study the association between common cold during pregnancy and pregnancy complications and delivery outcomes: gestational age/birth weight, in addition preterm birth and low birthweight. Method: In the population-based large data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities (HCCSCA), 1980- 1996, controls without congenital abnormalities were analysed. Results: Of 38,151 newborn infants, 5,475 (14.4%) had mothers with common cold. The prevalence of threatened preterm delivery, placental disorders and severe nausea and vomiting was lower while the occurrence of anemia was higher in pregnant mothers with common cold than in mothers without common cold. Mothers with common cold in pregnancy had 0.1 week shorter gestational age, thus the proportion of preterm births (9.8% vs 9.1%) was somewhat larger. However, mean birth weight was somewhat larger (3,305 vs 3,271 g) and the proportion of low birthweight newborns (4.2% vs 5.9%) was smaller. Conclusion: Common cold during pregnancy does not increase the occurrence of pregnancy complications except anemia, while delivery outcomes showed minor but opposite (higher rate of preterm birth and lower rate of low birthweight) changes.
- MeSH
- gestační stáří MeSH
- komplikace těhotenství MeSH
- lidé MeSH
- nachlazení MeSH
- porodní hmotnost MeSH
- těhotenství MeSH
- výsledek těhotenství MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- hodnotící studie MeSH
Background: Maternal cervical incompetence in pregnancy (CIP) showed an association with a higher rate of preterm births. The objective of this study was to determine the prevalence of CIP in Hungarian pregnant women, to determine the rate of preterm birth, and to check the preventive efficacy of preterm births due to CIP by therapeutic cerclage or bed rest alone. Methods: Analysis of the population-based large data set of 38,151 newborns (without any defects) of the Hungarian Case-Control Surveillance System of Congenital Abnormalities (HCCSCA), born during 1980-1996, i.e. 1.8% of Hungarian newborns. Prospective cohort analysis based on medically recorded variables of CIP, birth weight and gestational age. Results: A total of 2,795 (7.33%) newborns born to mothers with CIP. The newborns of mothers with CIP had a shorter gestational age at delivery (39.0 wk) and higher rate of preterm birth (11.1%) than the Hungarian reference sample without CIP (39.4 wk and 9.0%). Of 2,795 pregnant women with CIP 1,112 were treated by cerclage, while 1,683 with bed rest alone. The mean gestational age was shorter both after therapeutic cerclage (39.2 wk) and particularly bed rest alone (38.9 wk). The rate of preterm births was 9.1% and 12.7% after therapeutic cerclage and bed rest alone. Conclusions: CIP is very frequent in Hungary probably due the extremely high number of previous induced abortion performed by dilatation and curettage method. CIP associates with an increased risk for preterm births; however, this increased risk was reduced by bed rest alone and mainly by therapeutic cerclage.
- MeSH
- dítě MeSH
- financování organizované MeSH
- inkompetence hrdla děložního epidemiologie chirurgie MeSH
- komplikace těhotenství etiologie MeSH
- lidé MeSH
- novorozenec nedonošený MeSH
- předčasný porod epidemiologie etiologie MeSH
- prevalence MeSH
- těhotenství MeSH
- výsledek těhotenství epidemiologie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Geografické názvy
- Maďarsko MeSH
The objective of the study was to estimate the association of pregnant women with varicose veins of lower extremities (VVLE) and the possible risk for adverse birth outcomes and among them different congenital abnormalities (CAs) in their children. Prospectively and medically recorded VVLE were evaluated in 332 pregnant women who delivered infants with CA (case group) and 566 pregnant women with VVLE who delivered infants without CA (control group) and matched to cases were compared in the population-based data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities, 1980-1996. About one-quarter of pregnant women had chronic VVLE while new onset VVLE occurred in the rest of pregnant women. There was no higher risk for adverse birth outcomes of pregnant women with VVLE, in fact the rate of preterm birth and low birth weight was somewhat lower than in the newborns of pregnant women without VVLE. The comparison of VVLE occurrence in pregnant women who had offspring with 21 different CA groups and in pregnant women who later delivered babies without CA showed a higher risk only for pectus excavatum, a mild CA. In conclusion, VVLE in pregnant women does not associate with obvious hazard for their fetuses.
- MeSH
- antikoagulancia škodlivé účinky MeSH
- dospělí MeSH
- hrudník vpáčený epidemiologie etiologie MeSH
- hydroxyethylrutosid analogy a deriváty škodlivé účinky MeSH
- kardiovaskulární komplikace v těhotenství epidemiologie farmakoterapie MeSH
- lidé MeSH
- logistické modely MeSH
- novorozenec MeSH
- prospektivní studie MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- studie případů a kontrol MeSH
- těhotenství MeSH
- varixy epidemiologie farmakoterapie MeSH
- vrozené vady epidemiologie etiologie MeSH
- výsledek těhotenství MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Geografické názvy
- Maďarsko MeSH
