Lancet
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Rheumatoid arthritis is a systemic inflammatory disorder that mainly affects the diarthrodial joint. It is the most common form of inflammatory arthritis, and has a substantial societal effect in terms of cost, disability, and lost productivity. Although the pathogenesis of rheumatoid arthritis remains incompletely understood, much insight into the cellular and molecular mechanisms involved has been gained in the past decade. ⋯ Future studies will be directed at improving methods for early diagnosis and identification of patients with progressive disease, and at improving methods to identify candidates for subclasses of disease-modifying antirheumatic drugs (DMARDs). Long-term safety and efficacy data for the new DMARD agents and combination regimens will also further delineate efficacy and toxicity and thus the appropriate clinical context for use of these therapeutic approaches. The continuing elucidation of pathophysiological pathways relevant in rheumatoid arthritis, coupled with continuing advances in biotechnology and rational drug design, offer substantial hope for the continued development of increasingly potent and specific pharmacotherapy for treatment of rheumatoid arthritis.
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Randomized Controlled Trial Clinical Trial
Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomised controlled trial.
Wound infection after clean surgery is an expensive and often underestimated cause of patient morbidity, and the benefits of using prophylactic antibiotics have not been proven. Warming patients during colorectal surgery has been shown to reduce infection rates. We aimed to assess whether warming patients before short duration, clean surgery would have the same effect. ⋯ Warming patients before clean surgery seems to aid the prevention of postoperative wound infection. If applied according to the manufacturers guidelines these therapies have no known side-effects and might, with the support of further studies, provide an alternative to prophylactic antibiotics in this type of surgery.
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Randomized Controlled Trial Multicenter Study Clinical Trial
WHO multicentre randomised trial of misoprostol in the management of the third stage of labour.
Postpartum haemorrhage is a leading cause of maternal morbidity and mortality. Active management of the third stage of labour, including use of a uterotonic agent, has been shown to reduce blood loss. Misoprostol (a prostaglandin E1 analogue) has been suggested for this purpose because it has strong uterotonic effects, can be given orally, is inexpensive, and does not need refrigeration for storage. We did a multicentre, double-blind, randomised controlled trial to determine whether oral misoprostol is as effective as oxytocin during the third stage of labour. ⋯ 10 IU oxytocin (intravenous or intramuscular) is preferable to 600 microg oral misoprostol in the active management of the third stage of labour in hospital settings where active management is the norm.