Current medical research and opinion
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Randomized Controlled Trial Multicenter Study
Three-month, randomized, parallel-group comparison of brimonidine-timolol versus dorzolamide-timolol fixed-combination therapy.
Fixed combinations of 0.2% brimonidine-0.5% timolol and 2% dorzolamide-0.5% timolol are used to lower intraocular pressure (IOP). The objective of this study was to evaluate the IOP-lowering efficacy and ocular tolerability of brimonidine-timolol compared with dorzolamide-timolol when used as monotherapy or as adjunctive therapy to a prostaglandin analog (PGA) in patients with glaucoma or ocular hypertension. ⋯ Fixed-combination brimonidine-timolol provided the same or greater IOP lowering compared with fixed-combination dorzolamide-timolol. Both fixed-combination medications were safe and well-tolerated. Brimonidine-timolol received higher ratings of ocular comfort than dorzolamide-timolol. The duration of the studies was 3 months, and additional studies will be needed to compare the efficacy and tolerability of brimonidine-timolol and dorzolamide-timolol during long-term treatment.
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It is well known that patients suffering from bronchial asthma undergoing surgical procedures requiring general anesthesia (GA) or the administration of water soluble radiographic contrast media (RCM) have an increased risk of potentially severe bronchospasm. Nevertheless, little attention has been devoted to the possible preventive measures to reduce the occurrence of this potentially life-threatening event. It has been shown that the most important risk factor for bronchospasm during GA induction and/or the use of RCM is represented by a high degree of bronchial hyperreactivity with airway instability not adequately controlled by long-term anti-inflammatory treatment. ⋯ The authors suggest a therapeutic approach before surgical procedures requiring GA and/or RCM administration based on the degree of asthma control as assessed by clinical/functional criteria. In this setting, in addition to the necessity of obtaining the best control of airway reactivity, the authors suggest that an optimal control of asthma symptoms in 'real life' conditions might likely constitute a safety issue in asthmatic patients in the case of emergency procedures.
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Statins play a key role in the management of hypercholesterolemia and other dyslipidemias. However, statins exert several other actions, often referred to as 'pleiotropic'. This Editorial looks at the JUPITER trial (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin), examining, in particular, the occurrence of venous thromboembolism in the rosuvastatin and placebo groups, and discussing these findings in the context of the current literature. The authors conclude that statin use could perhaps be associated with reductions in the risk of venous thromboembolism, and call for further appropriately designed studies.
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Randomized Controlled Trial Multicenter Study Comparative Study
Comparison of postoperative pain outcomes after vertical or Pfannenstiel incision for major gynecologic surgery.
The Pfannenstiel incision is commonly used for gynecologic surgery. It is not known if this incision is associated with less postoperative pain compared to a vertical midline incision. Therefore, as part of a study to evaluate the postoperative analgesic effects and dose response of intravenous adenosine in patients undergoing open abdominal gynecologic surgery, this manuscript compares postoperative pain and analgesic consumption in patients who had a midline vertical incision or a Pfannenstiel incision. ⋯ There was no significant difference in postoperative pain and opioid consumption in patients undergoing major abdominal gynecologic surgery performed with either a midline or Pfannenstiel incision. However, it is important to note that since this a secondary analysis of data from a primary study investigating the dose response of IV adenosine, the patients were not prospectively randomized into the two incision types.
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To assess the validity of the patient global assessment (PGA) of the method of pain control, a single-item patient-reported outcome measure of a method of pain control for patients experiencing postoperative pain. ⋯ Findings suggest that both the content and construct validity of the PGA of the method of pain control in clinical trial settings are supported. However, this conclusion is potentially limited by the use of a narrow range of therapeutic interventions and, in some cases, small sample sizes in the clinical trials used to assess construct validity. The PGA of the method of pain control is an informative and useful measure for assessing pain control provided by different drug delivery systems for patients experiencing postoperative pain.