J Natl Med Assoc
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Randomized Controlled Trial Clinical Trial
Comparison of caudal ketamine with or without bupivacaine in pediatric subumbilical surgery.
In this prospective, randomized, double-blind study, we evaluated the perioperative analgesic efficacy of caudal ketamine with or without bupivacaine in 62 American Society of Anesthesiologists I-II children undergoing lower abdominal surgery. Patients were randomized into three groups, and all blocks were placed under general anesthesia. Group 1 (n=20) had caudal injection of plain 0.125% bupivacaine 1 mlkg(-1). ⋯ Patients in group 3 had the longest duration of analgesia compared to the other two groups. There was no significant difference in the incidence of side effects among the three groups. We conclude that ketamine can safely be used as an adjuvant to prolong the duration of caudal analgesia in this group of West African children.
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Carotid endarterectomy (CEA) has been shown to decrease future ischemic stroke risk in selected patients. However, clinical trials did not examine the risk-benefit ratio for nonwhites, who have a greater ischemic stroke risk than whites. In general, few studies have examined the effects of race on CEA use and complications, and data on race and CEA readmission are lacking. ⋯ The data suggest that CEA is performed safely in California. However, nonwhites had lower rates of initial CEA use but higher rates of in-hospital death and stroke than whites. Racial differences in stroke risk persisted after adjustment for patient and hospital factors. Finally, this study found that despite significant racial disparities in initial CEA use, whites and nonwhites were similar in their CEA readmission rates. These findings may suggest that screening initiatives are lacking for nonwhites, which may increase their risk for poorer outcomes.
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African-American men bear a greater burden of type-2 diabetes and its associated complications. The purpose of this analysis was to explore in greater depth themes that emerged in illness narratives of a small sample of African-American men living with type-2 diabetes. ⋯ Gender identity is a key cultural factor that influences health-related behaviors, including how men with type-2 diabetes engage with the healthcare system and manage their diabetes. Understanding African-American men's gender identity is an important component of cultural competency for physicians and can be consequential in patient outcomes.
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Comparative Study
Association between past urinary tract infections and current symptoms suggestive of chronic prostatitis/chronic pelvic pain syndrome.
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a major cause of illness, and its association with history of past urinary tract infections is unclear. We surveyed a racially, ethnically and socioeconomically diverse, community-based sample of adults aged 30-79 years in Boston, MA. This report gives estimates from the 2,301 men in the BACH survey: 700 black, 766 Hispanic and 835 white. ⋯ The number of urinary tract infections, particularly >3, was associated with symptoms suggestive of CP/CPPS (P < 0.01). There is a strong association between current symptoms of CP/CPPS and a history of urinary tract infections, particularly of multiple infections. The causality between chronic UTIs and CP/CPPS needs to be clarified by further study.
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Clostridium difficile-associated diarrhea (CDAD) has been increasingly diagnosed in hospitalized patients. The number of prescriptions for proton pump inhibitors (PPIs) has also increased significantly over time. Few studies have reported an association between CDAD and PPI use; however, the results are inconclusive. ⋯ Our findings indicate that PPI may be an emerging and potentially modifiable risk factor for CDAD and point out the importance of vigilance in prescribing PPI, particularly to patients who are hospitalized, taking multiple antibiotics and suffering from multiple comorbidities.