Medicine
-
Observational Study
A qualitative evaluation of an implementation study for cryptococcal antigen screening and treatment in Uganda.
Cryptococcal meningiti s causes 15% of AIDS-related deaths globally. Screening and preemptive treatment for cryptococcal antigen (CrAg) in the blood of persons with advanced HIV/AIDS reduces mortality. National and international HIV guidelines recommend CrAg screening; however, implementation studies and evaluations of how to integrate CrAg screening programs into existing HIV care infrastructure are lacking. ⋯ Collaboration with Ministries of Health for support with enforcing national guidelines, and procuring supplies is paramount to a successful CrAg screening program. Development of a CrAg screening and treatment program within the HIV clinic infrastructure has a number of barriers. Education and training of clinic staff, along with partnership with the Ministry of Health to ensure adequate supplies, facilitated the program.
-
The objective of this study was to evaluate the association between serum vitamin D deficiency and age-related macular degeneration (AMD) in Koreans through a clinical case-control pilot study. The study included 96 patients: 30 with late AMD, 32 with early AMD, and 34 normal controls. The patients with late AMD were divided into 2 subgroups based on the presence or absence of subretinal fibrosis on optical coherence tomography (OCT) images. ⋯ Among the 2 subgroups of patients with late AMD, those with subretinal fibrosis present on the OCT images showed a greater risk of serum vitamin D deficiency than the normal controls (OR = 7.54; 95% CI 1.34-42.51). However, there was no significant association between serum vitamin D deficiency and late AMD without subretinal fibrosis (OR = 1.89; 95% CI 0.40-8.92). Serum vitamin D deficiency may increase the risk of early and late AMD in Koreans, and may also be associated with subretinal fibrosis in this population.
-
Randomized Controlled Trial Multicenter Study
Oxycodone versus sufentanil in adult patient-controlled intravenous analgesia after abdominal surgery: A prospective, randomized, double-blinded, multiple-center clinical trial.
A randomized controlled trial was performed to compare analgesic effects and adverse effects of oxycodone and sufentanil in patient-controlled intravenous analgesia (PCIA) after abdominal surgery under general anesthesia. ⋯ Compared with sufentanil PCIA, oxycodone PCIA showed better analgesic effects, lower incidence of adverse complications, and less analgesic drug consumption during postoperative pain management.
-
The present study aims to assess the therapeutic effect of whole brain radiotherapy (WBRT) for brain metastases from non-small cell lung cancer stratified by graded prognostic assessment (GPA) through meta-analysis. ⋯ There were 2 randomized control trials identified eligible for the meta-analysis. Stereotactic radiosurgery (SRS)+WBRT did not significantly improved overall survival (OS) in 2 subgroups. (GPA <2: HR, 0.93; 95% confidence interval [CI], 0.61-1.40; P = .71), (GPA ≥2: HR, 1.28; 95% CI, 0.58-2.80; P = .54). The use of SRS+WBRT significantly extended brain tumor recurrence (BTR) free time in both subgroups (GPA <2: HR, 5.46; 95% CI: 2.09-14.22; P = .0005), (GPA ≥2: HR, 4.24; 95% CI: 2.24-8.04; P < .00001). The meta-analysis showed salvage therapy was more frequent among the SRS-alone in 2 subgroups (GPA <2: RR, 5.83; 95% CI: 1.47-23.06; P = .01), (GPA ≥2: RR, 2.53; 95% CI: 1.30-4.93; P = .006). The rate of grade 3 or 4 late radiation toxic effects was similar in 2 subgroups between SRS and SRS+WBRT CONCLUSIONS:: Because there are few studies to meet inclusion criteria, we cannot include more researches. The results of this analysis must be carefully interpreted in view of the unclear risk of bias in inclusion in the study. This meta-analysis of 2 randomized trails indicated that the combined treatment group did not show a survival benefit over SRS alone. However, SRS+WBRT improved BTR free time in the subgroup both GPA <2 and GPA ≥2 with the similar grade 3 or 4 late radiation toxicities.
-
Randomized Controlled Trial
Prophylactic infusion of phenylephrine increases the median effective dose of intrathecal hyperbaric bupivacaine in cesarean section: A prospective randomized study.
Phenylephrine infusion to prevent spinal-induced hypotension can attenuate cephalic spread of intrathecal bupivacaine. Therefore, we suspected the intrathecal dose requirement for bupivacaine may differ when using phenylephrine infusion to prevent spinal-induced hypotension in cesarean section. We designed a prospective, randomized study to determine the ED50 of hyperbaric bupivacaine for cesarean section under combined spinal-epidural anesthesia in healthy parturients with and without prophylactic phenylephrine infusion to prevent spinal-induced hypotension. ⋯ The ED50 of intrathecal hyperbaric bupivacaine is higher when phenylephrine infusion is used to prevent spinal-induced hypotension than when it is not used.