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PubMedDate not supplied

Injuries among Afghan refugees: review of evidence.

BACKGROUND: Injuries are a public health problem in developing countries resulting in major financial and productivity losses. Injuries in vulnerable populations, such as refugees, make an even greater impact on loss of life. Afghan refugees in Pakistan continue to form one of the world's largest refugee populations. This study systemically reviews the literature to estimate the magnitude and prevalence of intentional and unintentional injuries in Afghan refugees, and explores the implications of the findings for refugee healthcare policy and development of potential interventions specifically for Afghan refugees. METHODS: Electronic databases of MEDLINE, POPLINE, Refworld, and Winspirs were searched. In addition, a web search was conducted and specific organizational websites were reviewed. The search in developing countries was limited to studies in English or with an English abstract for the years 1966-2001. RESULTS: The literature review identified patients with reported war injuries who presented to hospitals. Injuries to extremities (45%) were more frequent than injuries to the head or neck (36%, p < 0.001), and thorax/abdomen (14%, p < 0.001) regions. A majority of the injuries were caused by explosives, which included landmines (32.5%), fragmentations, such as shrapnel (33%), and firearms (27%). The mean incidence of mortality in these studies was 11%. CONCLUSIONS: Despite such an extensive search, limited information was found pertinent to injuries in Afghan refugees residing in refugee camps. This dearth of literature on the prevalence of injuries, risk factors, and outcomes among this vulnerable group is a research and policy gap for public health. Specific quantitive and qualitative studies in this field are required to shape refugee healthcare policies and develop intervention programs.

Afghanistan↗

PubMed2001

Ocular perfusion and age-related macular degeneration.

PURPOSE: To review the role of ocular perfusion in the pathophysiology of age-related macular degeneration (AMD), the leading cause of irreversible blindness in the industrialized world. METHODS: Medline search of the literature published in English or with English abstracts from 1966 to 2000 was performed using various combinations of relevant key words. RESULTS: Vascular defects have been identified in both nonexudative and exudative AMD patients using fluorescein angiographic methods, laser Doppler flowmetry, indocyanine green angiography, and color Doppler imaging. CONCLUSION: Although these studies lend some support to the vascular pathogenesis of AMD, it is not possible to determine if the choroidal perfusion abnormalities play a causative role in nonexudative AMD, if they are simply an association with another primary alteration, such as a primary RPE defect or a genetic defect at the photoreceptor level, or if they are more strongly associated with one particular form of this heterogeneous disease. Further study is warranted.

Blood Flow Velocity↗

PubMed2002

Ocular perfusion abnormalities in diabetes.

PURPOSE: To review the role of ocular perfusion in the pathophysiology of diabetic retinopathy, one of the leading causes of irreversible blindness in the industrialized world. METHODS: We carried out a Medline search of the literature published in English or with English abstracts from 1966 to 2000 using various combinations of relevant key words. RESULTS: Hyperglycaemia leads to a wide variety of vascular abnormalities at the microvascular and macrovascular levels, including abnormal autoregulation. CONCLUSION: Three major aspects of ocular perfusion in diabetic retinopathy require additional investigation. Firstly, the precise mechanisms that link elevated glucose to dysfunction of retinal vascular cells need to be identified. Secondly, those factors that lead to both capillary dropout and to angiogenesis, twin processes that are linked to tissue hypoxia and lead to excess perfusion, increased risk of extravascular leakage and frank haemorrhage, must be carefully delineated. Finally, once specific knowledge of disease fundamentals has been amassed, tests of therapies to reverse or prevent these pathological processes can move forward.

Blood Flow Velocity↗

PubMed2005

More women in Europe and Australia have dental agenesis than their counterparts in North America.

DATA SOURCES: Medline and Embase were searched, using the following keywords: "hypodontia", "oligodontia", "anodontia", "agenesis", and "prevalence or incidence". Reference lists from retrieved articles were also examined. STUDY SELECTION: For inclusion, an article had to satisfy the following criteria: presence of an English abstract; the sample was representative for the underlying general population; the diagnosis of dental agenesis was based on a radiographic examination; the report presented information on the ethnic background; and the report presented prevalence of agenesis except third molars. DATA EXTRACTION AND SYNTHESIS: Data from Caucasian populations in North America, Australia and Europe were included in a meta-analysis. For the prevalence in African-American, Chinese and Arab groups, only indications could be reported because of a limited number of studies. Multiple-regression analysis was applied to evaluate the influence of chronological age, sample size, continent and year of publication. Statistical significance was established at P<0.05. The prevalence of agenesis per tooth type, affected patients and number of missing teeth per patient was calculated as far as reported in the papers. For the comparison of the prevalence for males and females, the relative risk (RR) was calculated. RESULTS: The search identified 141 articles, of which 31 met the inclusion criteria. Agenesis differs by continent and gender: the prevalence for both sexes was higher in Europe (males 4.6%; females 6.3%) and Australia (males 5.5%; females 7.6%) than for North-American Caucasians (males 3.2%; females 4.6%). In addition, the prevalence of dental agenesis in females was significantly higher than in males for all three continents, with an RR of 1.37 (95% CI, 1.28-1.45). The mandibular second premolar was the most affected tooth, followed by the maxillary lateral incisor and the maxillary second premolar. Unilateral occurrence of dental agenesis is more common than bilateral occurrence. Bilateral agenesis of maxillary lateral incisors is more common, however, than unilateral agenesis. In most patients, dental agenesis involved only one (48%) or two teeth (35%). CONCLUSIONS: The prevalence of dental agenesis in Europe and Australia is higher than in North America. The overall prevalence of agenesis in the maxilla is comparable with that in the mandible, but a marked difference was found between both jaws regarding tooth type. Absence of one or two permanent teeth is found in the majority of the subjects with dental agenesis.

Comment↗

PubMed2000

Intrafamilial transmission of hepatitis C virus: a systematic review.

To examine the risk of hepatitis C virus (HCV) transmission between patients infected with HCV and their household members (siblings, offspring and parents), as well as their stable heterosexual partners, a systematic search of the MEDLINE database was undertaken for all relevant articles published up to June 1997. English language publications or those supplemented with an English abstract that reported studies concerning hepatitis C, and household, intrafamilial, sexual and intraspousal transmission of HCV, were reviewed. Data from uncontrolled and controlled studies were collected and analysed separately. Studies reporting the exclusive use of first-generation anti-HCV antibodies without supplemental tests were excluded. Pre- or postnatal mother-to-child transmission of HCV and homosexual and heterosexual transmission of HCV among non-permanent couples were not included. Unweighted data from individual studies were pooled for each category of family member. Data were also analysed separately for Japanese and non-Japanese studies because there is evidence that intrafamilial transmission may differ, based on endemicity of the viral infection. Comparisons were drawn only from controlled studies that reported the prevalence of HCV in family members of both HCV-positive and HCV-negative controls. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated for each family category. In uncontrolled studies, the pooled prevalence of anti-HCV among 4250 stable sexual contacts of patients with HCV-related chronic liver disease (CLD) was 13.48%, while the pooled prevalence of anti-HCV among 580 stable sexual contacts of patients who contracted HCV as a result of multiple transfusions was 2.41%. In controlled studies, the pooled prevalence of anti-HCV among 175 siblings and household contacts of patients with CLD was 4.0% compared with 0% among 109 contacts of anti-HCV-negative controls (OR 9.75, 95% CI 0.91 ad infinitum). The pooled prevalence of anti-HCV among offspring of Japanese HCV-infected CLD patients was 17% compared with 10.4% among offspring of HCV-negative Japanese controls (OR 1.77, 95% CI 1.21-2. 58, P=0.002). The pooled prevalence of anti-HCV among spouses of non-Japanese HCV-infected CLD patients was 15.2% compared with 0.9% in the spouses of non-Japanese HCV-negative controls (OR 20.57, 95% CI 6.05-84.08, P=0.0001). The prevalence of anti-HCV among non-Japanese offspring and Japanese spouses of HCV-infected patients was not increased compared with controls. HCV genotype homology and mutant analysis studies in pairs of HCV-infected patients and their HCV-infected contacts showed that concordant genotype homology was found in 66% of non-sexual contacts and in 74% of sexual contacts. Sequence homology of greater than 92% was found in 19 out of 35 pairs. Hence, evidence exists that familial, non-sexual and sexual transmission of HCV does occur. In Japanese patients, transmission probably occurs in younger family members while, in non-Japanese patients, transmission probably occurs at an older age, after contact with an HCV-infected spouse.

Disease Transmission, Infectious↗

PubMed2000

Are we paying a high price for surgical sympathectomy? A systematic literature review of late complications.

The purpose of this article was to systematically review the literature in order to assess (1) the current indications for surgical sympathectomy and (2) the incidence of late complications collectively and per indication. All types of upper or lower limb surgical sympathectomies are included. An extensive search strategy looked for controlled trials and observational studies or case series with an english abstract. Out of 1,024 abstracts from MEDLINE and 221 from EMBASE, 135 articles reporting on 22,458 patients and 42,061 procedures (up to april 1998) fulfilled the inclusion criteria. Weighted means were used to control for heterogeneity of data. No controlled trials were found. The main indication was primary hyperhidrosis in 84.3% of the patients. Compensatory hyperhidrosis occurred in 52.3%, gustatory sweating in 32.3%, phantom sweating in 38.6%, and horner's syndrome in 2.4% of patients, respectively, with cervicodorsal sympathectomy, more often after open approach. Neuropathic complications (after cervicodorsal and lumbar sympathectomy) occurred in 11.9% of all patients. Compensatory hyperhidrosis occurred 3 times more often if the indication was palmar hyperhidrosis instead of neuropathic pain (52.3% versus 18.2%), whereas neuropathic complications occurred 3 times more often if the treatment was for neuropathic pain instead of palmar hyperhidrosis (25.2% versus 9.8%). Surgical sympathectomy, irrespective of approach, is accompanied by several potentially disabling complications. Detailed informed consent is recommended when surgical sympathectomy is contemplated.

Journal Article↗

PubMed2004

Palliative chemotherapy for advanced gastric cancer.

BACKGROUND: More than two-thirds of patients diagnosed with gastric cancer will have unresectable disease. They present a difficult problem to clinicians as to whether to choose a strictly supportive approach or expose patients to the side-effects of a potentially ineffective treatment. The objective of this article is to review the clinical trials utilizing cytotoxic chemotherapy in patients with advanced gastric cancer. METHODS: A computerized (Medline) search was carried out to identify papers published on this topic between 1966 and 2003. Only articles with an English abstract were reviewed, and studies only presented in abstract form were not included in the analysis. RESULTS: A total of 101 trials were subsequently identified. Four randomized trials compared palliative chemotherapy with best supportive care in 174 patients with advanced gastric cancer. Effectiveness and side-effects were evaluated in 73 phase II studies and 24 randomized phase III trials. CONCLUSION: Analysis of results shows chemotherapy to be superior to best supportive care alone. Combination chemotherapy compared with monochemotherapy is associated with significantly higher overall (complete plus partial) response rates but nevertheless results in similar survival. ECF (epirubicin, cisplatin and 5-fluorouracil) currently represents one of the most effective regimens for advanced gastric cancer, whereas among the newer combinations, irinotecan- or taxane-based regimens have also given promising results. In patients with a poor performance status, consideration could be given to leucovorin-modulated 5-fluorouracil alone. Prognosis for the majority of patients, however, remains poor, as increases in survival were moderate at best.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2003

Minimally invasive approaches to the management of pancreatic pseudocysts: review of the literature.

Although one third or more of pancreatic pseudocysts might resolve spontaneously, interventional therapy is required for most. Several minimally invasive management approaches are now available, including percutaneous drainage under radiologic control, endoscopic transpapillary or transmural drainage, and laparoscopic internal drainage. This paper reviews the methodology, applications, advantages, shortcomings, and results of these management approaches. A computerized search was made of the MEDLINE, PREMEDLINE, and EMBASE databases using the search words pancreatic and pseudocysts and all relevant articles in English Language or with English abstracts were retrieved. In addition, cross-references from the identified articles were reviewed. Percutaneous drainage is best applied to pseudocysts complicated with secondary infection and in critically ill patients or those unfit for surgery. Radiologic drainage, however, risks the introduction of secondary infection and the formation of an external pancreatic fistula, and is associated with high recurrence rates. Endoscopic transpapillary drainage is beneficial for pseudocysts that communicate with the pancreatic duct and when a dependent drainage could be established. Endoscopic transmural (transgastric or transduodenal) drainage offers good results in the management of suitably located pseudocysts that complicate chronic pancreatitis, but is associated with high rates of failure to drain, secondary infection, and recurrence when pseudocysts that complicate acute necrotizing pancreatitis are approached. Laparoscopic pseudocyst gastrostomy or pseudocyst jejunostomy achieves adequate internal drainage, facilitates concomitant debridement of necrotic tissue within acute pseudocysts, and achieves good results with minimal morbidity. A randomized controlled trial that compares laparoscopic and endoscopic drainage techniques of retrogastric pseudocysts of chronic pancreatitis is required.

Endoscopy, Digestive System↗

PubMed2005

Current and future therapeutic approaches in idiopathic pulmonary fibrosis.

Idiopathic pulmonary fibrosis (IPF) is a lethal form of idiopathic diffuse lung disorders for which no current treatment is effective. The aim of the present study was to systematically review the current status and novel therapies of IPF, with emphasis on controlled trials. The studies selected included randomised controlled trials using drugs alone and/or in combination for the treatment of adults with IPF and meta-analyses, published in English. Abstracts of identified articles were retrieved and articles possibly fulfilling inclusion criteria were retrieved in full. Two reviewers independently assessed trial quality if there were any included studies. Data quality was based on place of publication and relevance to clinical care. There is a lack of good-quality studies regarding the effectiveness of the most used drugs, including corticosteroids and noncorticosteroid immunosuppressive agents. Oral corticosteroids are the usual treatment. Other therapies either alone or in combination with corticosteroids are widely used, including azathioprine, cyclophosphamide and colchicine. Interestingly, clinical trials with novel drugs, mainly antifibrotic, anticytokine and immunoregulatory, are currently being investigated in various trial phases. In conclusion, at present, there are no evidence-based therapies for idiopathic pulmonary fibrosis. Further controlled studies are warranted to improve the evidence base for clinical practice.

Clinical Trials as Topic↗

PubMed2006

Postoperative chemotherapy for gastric cancer.

INTRODUCTION: Adjuvant chemotherapy for gastric cancer after potentially curative surgery has been under clinical investigation for more than four decades. However, potentially curative resection can be performed in only 30%-50% of patients. The objective of this article is to review briefly the clinical trials available in the current literature using adjuvant cytotoxic chemotherapy in patients with gastric cancer after potentially curative surgical resection. METHODS: Computerized (MEDLINE) and manual searches were performed to identify papers published on this topic between 1965 and 2005. Only articles with an English abstract were reviewed for inclusion; information abstracted included histologic proof of diagnosis, number of patients, dose and modality of treatment, survival duration, and side effects. RESULTS: Forty-three reports were identified. Single-agent chemotherapy was evaluated in four clinical trials, and postoperative combination chemotherapy was evaluated in 33 trials. Furthermore, we identified five meta-analyses. Five-year survival rates ranged from 12%-91.2%, and the median survival durations were 13-60+ months. Adjuvant chemotherapy, when compared with surgery alone, seems to result in longer survival. CONCLUSION: The high rate of recurrence, even in patients undergoing state-of-the art curative resection, suggests that effective adjuvant chemotherapy might indeed be an attractive concept to improve the overall outcome of patients with gastric cancer. However, because there is no standard regimen for postoperative treatment at the moment, patients with R0-resected (no residual tumors) gastric cancer should be offered the opportunity to participate in prospective clinical trials.

Antibiotics, Antineoplastic↗

PubMed1982

A pharmacological study of the anti-inflammatory activity of Chinese herbs. A review.

A considerable number of Chinese medical herbs have been found to be anti-inflammatory upon screening for the inhibition of acute inflammation and allergic reaction, and for the suppression of adjuvant arthritis. Most of this research has been published exclusively in Japanese, and consequently is little known internationally. In this review, we will introduce the most recent conclusions drawn from current pharmacological research on the anti-inflammatory action of various Chinese medicinal herbs being undertaken in Japan. Due to limitations of space, we mention only herbs showing anti-inflammatory activity in vivo when administered intra-orally, and having low toxicity. We will also introduce some popular Chinese medical prescriptions used in the treatment of arthritis, hepatitis and nephritis and attempt to explain their anti-inflammatory action resulting from the synergistic action of the herbs contained in these prescriptions. All references cited in this review were either written originally in English or have an English abstract.

Adjuvants, Immunologic↗

PubMed1999

Nonsurgical management of malignant thymoma.

BACKGROUND: Thymoma is a rare tumor entity. Surgery remains the mainstay of treatment, but radiation and chemotherapy also have been applied widely in both the adjuvant and the palliative setting. The objective of this study was to review briefly the clinical trials available in the current literature utilizing nonsurgical oncologic treatment (radiotherapy and chemotherapy) either in patients with advanced (i.e., locally inoperable) or metastatic thymoma or as an adjunct to surgery. METHODS: A computerized (MEDLINE) and a manual search was performed to identify articles published on this topic between 1965-1998. Only articles with an English abstract were reviewed for inclusion; information abstracted included histologic proof of diagnosis, number of patients, dose and modality of treatment, assessment of response, response rate, survival duration, and side effects. RESULTS: Seventy-one trials were identified subsequently. These included 51 chemotherapy studies in a total of 410 patients (including 19 single agent trials and 32 combination chemotherapy trials) and 20 radiotherapy studies. In the adjuvant setting, radiation appeared to result in a higher survival rate compared with historic controls as well as excellent local control in patients with advanced stage of disease, whereas no apparent benefit was observed in patients with Masaoka et al. classified Stage I disease. The large majority of chemotherapeutic studies were case reports or Phase II trials of advanced disease, whereas no prospectively randomized trials were performed. Response rates were relatively heterogeneous and ranged between 24% and 100%, not including the results published in single case reports, and response rates >50% have been found consistently with the application of polychemotherapy. In the absence of randomized trials, multimodality approaches using induction chemotherapy followed by resection and consecutive radiation have produced highly promising results in terms of resectability and long term survival, even in patients with advanced disease. CONCLUSIONS: To the authors' knowledge, there is no standard approach to advanced thymoma apart from surgery (i.e., total resection whenever possible). Despite reports of long term disease control, symptomatic palliation, and encouraging survival data, the majority of studies involved only a small number of patients and were performed in a Phase II approach. Large scale, randomized trials to elucidate the potential of multimodality approaches clearly are needed, and patients with thymoma should be included in such studies.

Antineoplastic Agents↗

PubMed2003

[Chronic urticaria and infectious diseases].

INTRODUCTION: Infectious diseases are often considered as a classic cause of chronic urticaria. Nevertheless, laboratory investigations greatly vary from one centre to the other and the link between the infection and skin signs does not rely on hard data. The purpose of this work was a systematic analysis of the published cases of urticaria associated with infection. METHODS: We did a Medline search, using the key-words "urticaria" and "infection/infectious disease"; a second analysis was carried out in groups of infectious agents (viruses, bacteria, parasites) and using each germ name as a key-word. We excluded cases of acute urticaria and articles without English abstract, as well as general reviews without clinical data. RESULTS: No viral cause has ever been clearly documented in chronic urticaria; the screening of viral markers does not yield significant results, compared to the general population (hepatitis B, hepatitis C, HIV). Among bacterial infections, sinusitis and dental infection are not significantly associated with urticaria, and their treatment produces variable and poorly documented results. Helicobacter pylori infection was studied in numerous series, which produced contrasted results: the prevalence was not higher than in controls in the majority of comparative studies; conversely, the outcome of antibiotic treatment was not significant in randomised trials. Only anecdotal series of cases documented a link between parasites and chronic urticaria. Two French studies have suggested a high prevalence of Toxocara canis markers in chronic urticaria, but anti-parasitic treatment had only inconstant effects. CONCLUSION: There is not enough clear-cut data to affirm a direct link between chronic urticaria and infectious diseases, except in occasional case reports. Therefore, systematic screening for infectious markers cannot be recommended in chronic urticaria. A role of Toxocara canis infections should be re-evaluated by controlled studies.

Animals↗

PubMedDate not supplied

Stability of drug additives to peritoneal dialysate.

OBJECTIVE: The primary literature was reviewed to determine the stability of drug additives in peritoneal dialysis solutions. DATA SOURCES: A MEDLINE search and retrieval, covering the period 1981 to 1994, was undertaken to identify relevant original literature. Additional references were identified from citations within the original literature. Non-English literature was excluded unless an English abstract was provided. STUDY SELECTION: Forty-nine studies were identified. Of these, 24 were directly related to drug stability, 13 were related to the clinical use of the drug additives but included no stability data, and 12 examined other, nonstability aspects of in vitro activity of antibiotics, additives, or drug adsorption in peritoneal dialysis bags and tubing. DATA EXTRACTION: Data included concentrations of drug additives and dialysate solutions, duration and temperatures of storage conditions, types of assay, and whether they were stability-indicating. RESULTS: Stability was defined as the duration of time that the drug concentration remained at 90% or more of the original concentration. Stability was examined under a large variety of conditions. Thirty-one drugs were identified from 20 manuscripts as single-drug additives. Most beta-lactams were stable for 1-2 weeks in a refrigerator and for several days at room temperature. Aminoglycosides were stable for 1-2 days at room temperature. Glycopeptides were stable for several weeks refrigerated or at room temperature. Prolonged storage at room temperature resulted in instability of cefotaxime, ceftazidime, ceftriaxone, and miconazole. Eleven drugs were identified from seven manuscripts as drug combination studies and showed similar stability as single agents. Dialysate concentration appeared to have minimal effect on stability. CONCLUSIONS: Drug additives in peritoneal dialysate, singly or combined, should be avoided unless data are available to support their stability. Additives should be made as close as possible to the time of the exchange. Alternatively, additives should be stored refrigerated, then warmed prior to use. The practice of preparing numerous bags at one time should be avoided. Finally, stability data do not indicate sterile integrity of the dialysate.

Adsorption↗

PubMed1988