Medicine
-
Comparative Study Observational Study
Differences in human immunodeficiency virus-1C viral load and drug resistance mutation between plasma and cerebrospinal fluid in patients with human immunodeficiency virus-associated cryptococcal meningitis in Botswana.
To determine effects of cryptococcal meningitis (CM) on human immunodeficiency virus (HIV)-1C cerebrospinal fluid (CSF) viral escape, CSF/plasma viral discordance, and drug resistance mutation (DRM) discordance between CSF and plasma compartments, we compared CSF and plasma viral load (VL) and DRMs in individuals with HIV-associated CM in Botswana. This cross-sectional study utilized 45 paired CSF/plasma samples from participants in a CM treatment trial (2014-2016). HIV-1 VL was determined and HIV-1 protease and reverse transcriptase genotyping performed. ⋯ HIV-1 DRM discordance was found in 3/26 (11.5%); 1 had I84IT and another had M46MI in CSF only. The third had K101E in plasma and V106 M in CSF. Our findings suggest that HIV-1 escape and DRM discordance may occur at lower rates in participants with advanced HIV-disease and CM compared to those with HIV associated neurocognitive impairment.
-
Meta Analysis
Coronary angiography or not after cardiac arrest without ST segment elevation: A systematic review and meta-analysis.
This meta-analysis aimed to review the available evidence and evaluate the necessity of immediate coronary angiography (CAG) to obtain positive outcomes for out-of-hospital cardiac arrest (OHCA) patients without ST segment elevation. ⋯ Our meta-analysis demonstrates that there may be significant benefits in performing immediate CAG on patients who experience OHCA without ST segment elevation.
-
Sciatica is usually caused by lumbar spine disease; the incidence of sciatica from extra-spinal causes is noted to be only about 0.09%. ⋯ We suggest practitioners check for common iliac artery aneurysms in the diagnosis of symptoms mimicking spinal cord origin sciatica, especially in elder patients.
-
Non-variceal gastrointestinal bleeding is a common critical disease worldwide, and according to relevant guidelines, surgery and interventional treatment are the final therapies. However, few studies have reported on therapeutic strategies to employ when the ultimate treatment fails. This report offers a reasonable option for hemostasis after surgery and interventional treatment both fail. ⋯ The OTSC system can represent a reasonable option for ulcer hemostasis after surgery when other interventional therapies have failed.
-
Reduction malarplasty is a routine clinical procedure among Asian women, but the traditional surgical methods are still associated with serious complications, such as nonunion of the osteotomy sites. Revisional surgery to correct such complications is common, but poor bone healing in the osteotomy area presents a challenge to plastic surgeons. In this report, the authors present a new technique for revision malarplasty that uses the piezosurgery (piezoelectric bone surgery) approach. ⋯ This report presents a novel therapeutic option for surgical revision of failed malarplasty. Piezosurgery can help overcome the limitations of traditional surgical methods by reducing bone resorption, preventing resorption of the bone in revision malarplasty, modifying the degree of inward and upward movement of the zygomatic bone by facilitating adjustment of the position of the drill hole in the cortex of the bone stump for stable fixation. Hence piezosurgery can be a simple, accurate, and non-invasive osteotomy method for revision malarplasty.