Lancet
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
The effectiveness of combined oral lysine acetylsalicylate and metoclopramide compared with oral sumatriptan for migraine.
Aspirin is commonly used to treat migraine attacks, although sumatriptan, a much more expensive treatment, is also effective. We compared a combination of lysine acetylsalicylate (equivalent to 900 mg aspirin) and 10 mg metoclopramide (LAS+MTC) with oral sumatriptan (100 mg) and placebo in 421 patients with migraine. LAS+MTC was as effective as sumatriptan with a decrease of headache from severe or moderate to mild or none of 57% and 53%, respectively, for the first migraine attack treated. ⋯ LAS+MTC was significantly more effective in the treatment of nausea than sumatriptan (p < 0.0001) and was better tolerated (adverse events in 18% and 28%, respectively, p < 0.05). LAS+MTC is as effective as sumatriptan in the treatment of migraine attacks. It is also much cheaper.
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Randomized Controlled Trial Clinical Trial
Efficacy trial of malaria vaccine SPf66 in Gambian infants.
SPf66 malaria vaccine is a synthetic protein with aminoacid sequences derived from pre-erythrocytic and asexual blood-stage proteins of Plasmodium falciparum. SPf66 was found to have a 31% protective efficacy in an area of intensive malaria transmission in Tanzanian children, 1-5 years old. We report a randomised, double-blind, placebo-controlled trial of SPf66 against clinical P falciparum malaria in Gambian infants. 630 children, aged 6-11 months at time of the first dose, received three doses of SPf66 or injected polio vaccine (IPV). ⋯ No significant differences in parasite rates or in any other index of malaria were found between the two groups of children. The findings of this study differ from previous reports on SPf66 efficacy from South America and from Tanzania. In The Gambia, protection against clinical attacks of malaria during the rainy season after immunisation in children 6-11 months old at time of the first dose was not achieved.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Which anticonvulsant for women with eclampsia? Evidence from the Collaborative Eclampsia Trial.
Eclampsia, the occurrence of a seizure in association with pre-eclampsia, remains an important cause of maternal mortality. Although it is standard practice to use an anticonvulsant for management of eclampsia, the choice of agent is controversial and there has been little properly controlled evidence to support any of the options. 1687 women with eclampsia were recruited into an international multicentre randomised trial comparing standard anticonvulsant regimens. Primary measures of outcome were recurrence of convulsions and maternal death. ⋯ Women allocated magnesium sulphate were also less likely to be ventilated, to develop pneumonia, and to be admitted to intensive care facilities than those allocated phenytoin. The babies of women who had been allocated magnesium sulphate before delivery were significantly less likely to be intubated at the place of delivery, and to be admitted to a special care nursery, than the babies of mothers who had been allocated phenytoin. There is now compelling evidence in favour of magnesium sulphate, rather than diazepam or phenytoin, for the treatment of eclampsia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomised comparison of combined spinal-epidural and standard epidural analgesia in labour.
Epidural analgesia has a well-established role in labour, but has the drawbacks of delayed onset and motor blockade. The combined spinal-epidural technique may overcome these drawbacks. We carried out a randomised observational study to assess maternal satisfaction with the standard and combined techniques among 197 women in labour. ⋯ In the standard epidural group 32 had leg weakness at 20 min (p = 0.001), and the proportion of mothers with weakness increased in this group during labour. There were no differences in side-effects, except for mild pruritus, which was more common in the combined spinal-epidural group (42 vs 1%; p < 0.0001). Overall, women seem to prefer the low-dose combined spinal-epidural technique to standard epidurals, perhaps because of the faster onset, less motor block, and feelings of greater self-control.
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Randomized Controlled Trial Clinical Trial
Prevention of atelectasis during general anaesthesia.
Atelectasis is an important cause of impaired gas exchange during general anaesthesia; it causes pulmonary shunting. We studied the effects of gas composition on the formation of atelectasis and on gas exchange during the induction of general anaesthesia. In 12 adult patients, the lungs were ventilated with 30% oxygen in nitrogen during anaesthesia induction, and in another 12, a conventional technique was used (100% oxygen during induction and 40% oxygen in nitrogen thereafter). ⋯ In subgroup B, the shunt increased from 2.6 (5.2)% to 9.8 (5.7)% of cardiac output. These results suggest that the composition of inspired gas is important in atelectasis formation during general anaesthesia. Use of a lower oxygen concentration than is now standard practice might prevent the early formation of atelectasis.