Analgesia and hydration remain the only safe treatment for painful crises of sickle cell disease; hydroxyurea is effective, but the toxicity is still a problem. Piracetam is a nootropic drug that has reportedly been effective and non-toxic in sickle cell patients, but most studies were not placebo-controlled and included a small number of patients. The present study evaluated the drug in a double-blind crossed placebo-controlled clinical trial in 73 children and adolescents suffering from moderate to severe painful crises for 13 months. Information regarding frequency and severity of pain was acquired through monthly clinical evaluation, visits and house calls, and 4,300 weekly questionnaires filled out by the patients in their domiciles. A monthly pain score was calculated for each patient. Pain was the most frequent adverse manifestation of the disease stressing its significant bio-psycho-social impact. Although nearly all patients and relatives reported a better clinical course throughout the whole study, the drug was ineffective in the prevention of painful crises. This placebo effect may be ascribed to an unplanned and unsystematic ‘cognitive-behavioural’ management of the children. The pain score in the second semester of the study – both in the experimental and in the control groups – was significantly smaller than that in the first semester. In conclusion, piracetam was found to be ineffective in the prevention of painful crises; a powerful placebo effect due to adequate patient care was demonstrated.
This study attempts to understand the relationship between physical activity, strength and mobility with depression, cognitive state and health status among the elderly in Portugal and identify which measures best relate with these. Using a descriptive, cross-sectional and correlational study, a sample of 118individuals was selected by exclusion and inclusion criteria. The measuring instruments used were the Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), 12-Item Short Form Health Survey (SF-12), International Physical Activity Questionnaire (IPAQ), Timed Up and Go (TUG) and Hand Grip Strength (HGS). The sample had a normal distribution. Pearson's test and ANOVA were used for the statistical analysis and revealed meaningful positive correlations between GDS and SF-12, IPAQ, TUG and HGS and also in MMSE with SF-12 [physical and mental dimensions], right HGS, left HGS and IPAQ. A meaningful negative correlation was also found in MMSE with TUG. SF-12 presented a significant negative correlation with TUG. Left HGS revealed a significant positive correlation to SF-12 in both physical and mental dimensions. However, right HGS was only significant to the physical dimension. IPAQ had no significant correlation with SF-12. All the measures had a meaningful correlation with depression (GDS) and cognitive state (MMSE). Applying simple instruments of easy application such as TUG have shown good values of correlation with depression, cognitive state and health.
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