RESUMEN
Post-thrombotic syndrome (PTS) is a common complication after deep vein thrombosis (DVT) and has a major impact on physical symptoms, quality of life (QoL) and economic costs. Relatively simple lifestyle interventions as physical exercise might reduce PTS severity and increase QoL. To evaluate the direct and long-term effects of physical activity in patients with an acute or previous DVT. We conducted a systematic review through an additional search from 2007 up to March 2022, to complement the comprehensive systematic review of Kahn et al. Articles evaluating the effect of exercise after a DVT including symptoms, QoL and the incidence and severity of PTS, were included. Quality of the studies was assessed using a GRADE-like checklist and results were reported according to the PRISMA Statement. Ten studies were included, seven randomized controlled trials and three cohort studies. We identified three types of physical activity based on timing and duration; (1) early mobilisation in the acute phase of the DVT; (2) short duration exercise 1 year after DVT and (3) prolonged exercise during follow-up after a previous DVT. Early mobilisation showed improvement in QoL and pain reduction and after 2 years it resulted in a significant reduction of PTS severity. Prolonged supervised exercise resulted in improvement of QoL. In addition, positive effects on symptoms of venous insufficiency and muscle functions were observed. None of the included studies reported an increased risk of PTS or worsening of symptoms due to physical activity. Physical exercise after a DVT is safe, improves QoL, reduces pain and decreases PTS severity. Lifestyle intervention such as guided individualized training programs can be a useful supplementary therapy for patients after a DVT or for PTS patients. Optimal training programs may be identified by further studies that improve patient-oriented outcomes for both adults and children after a DVT.
Asunto(s)
Síndrome Postrombótico , Trombosis de la Vena , Adulto , Niño , Humanos , Trombosis de la Vena/complicaciones , Calidad de Vida , Síndrome Postrombótico/complicaciones , Síndrome Postrombótico/terapia , Ejercicio Físico , DolorAsunto(s)
Dermatología/organización & administración , Úlcera de la Pierna/terapia , Enfermeras y Enfermeros , Enfermería/organización & administración , Anciano , Cardiología/organización & administración , Vendajes de Compresión , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , Resultado del Tratamiento , Úlcera , Úlcera Varicosa/terapia , Cicatrización de HeridasRESUMEN
The alkylation of phenytoin, mephenytoin and primidone with n-alkyl iodides in N,N-dimethylacetamide with tetramethylammonium hydroxide was investigated by gas chromatography. With methyl iodide phenytoin and mephenytoin were each converted into a single derivative; the use of other alkyl iodides yielded more than one product. Primidone was converted with methyl iodide and butyl iodide into a major derivative (> 90%) and a minor one. Butylation of the compounds by this method was compared with butylation in an acetone-butyl iodide mixture with potassium carbonate, caesium carbonate or silver oxide added, and with on-column butylation. All these methods resulted in the production of more than one derivative. The derivatives were identified by mass spectrometry and by 1H NMR and 13C NMR. With the acetone-butyl iodide-silver oxide method the main derivatives were O-butylated compounds. The other methods yielded predominantly N-butylated derivatives.