Interventions to prevent mother-to-child transmission in breastfeeding mothers with HIV: a systematic review and meta-analysis of randomized controlled trials

ABSTRACT This study aimed to systematically review interventions to prevent mother-to-child transmission of HIV during breastfeeding. We conducted a systematic review and meta-analysis using specific criteria to identify randomized controlled trials that focused on pregnant and breastfeeding women living with HIV and their children from birth to 2 years of age. We extensively searched electronic databases, including Web of Science, Scopus, PubMed, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Google Scholar up to October 24, 2023. After screening 3,110 titles and abstracts, we reviewed 306 full texts. Of these, we assessed the quality and risk of bias of fifty-five articles, ultimately identifying seven studies. Four of these studies, which focused on antiretroviral therapy (ART), were included in the meta-analysis. There was little heterogeneity in study methodology and pooled estimates. The postnatal HIV transmission rate was found to be 0.01 (95%CI: 0.00 - 0.02). Therefore, the risk of mother-to-child transmission among breastfeeding mothers with HIV was significantly lower in the intervention groups than in the placebo groups. Analysis of funnel plots and Egger's test (p = 0.589) showed no evidence of publication bias. In addition to the four articles, two studies compared different ART regimens and one study compared the administration of high-dose vitamin A to the mother or the child. The results suggest that the use of ART significantly reduces the risk of postnatal HIV transmission compared with placebo. However, the effectiveness of different ART regimens or other therapies, including high-dose vitamin A, is unclear.

Freer Test for an Intraoperative Evaluation of a Lisfranc Joint Injury: A Technical Report / 대한족부족관절학회지

Failure to achieve stable fixation during surgery for a Lisfranc joint injury leads to subtle instability that causes dysfunction and posttraumatic osteoarthritis. Therefore, it is important to check for appropriate fixation during surgery. This paper reports a test that evaluates the joint instability dynamically during the open reduction of the Lisfranc joint and checks the stability after fixation. a Freer elevator was inserted into the interosseous area between the medial cuneiform and second metatarsal base, and a twisting force was applied to evaluate the dynamic instability of the Lisfranc joint. After fixation of the Lisfranc joint, the stability of the fixation could be tested by trying this maneuver with the Freer elevator. Overall, the Freer test can be considered a valuable test in open surgery for a Lisfranc joint injury.

Freer Test for an Intraoperative Evaluation of a Lisfranc Joint Injury: A Technical Report / 대한족부족관절학회지

Failure to achieve stable fixation during surgery for a Lisfranc joint injury leads to subtle instability that causes dysfunction and posttraumatic osteoarthritis. Therefore, it is important to check for appropriate fixation during surgery. This paper reports a test that evaluates the joint instability dynamically during the open reduction of the Lisfranc joint and checks the stability after fixation. a Freer elevator was inserted into the interosseous area between the medial cuneiform and second metatarsal base, and a twisting force was applied to evaluate the dynamic instability of the Lisfranc joint. After fixation of the Lisfranc joint, the stability of the fixation could be tested by trying this maneuver with the Freer elevator. Overall, the Freer test can be considered a valuable test in open surgery for a Lisfranc joint injury.

Reduction of propofol infusion pain using target controlled infusion of remifentanil

BACKGROUND: Propofol has a high incidence of infusion pain. We hypothesized that propofol infusion pain might be prevented by infusing remifentanil before starting the propofol infusion in a clinical setting where target controlled infusions (TCI) of both drugs were used. We compared the efficacy of remifentanil TCI administered 90 seconds before propofol TCI with remifentanil TCI and propofol TCI given immediately after a 40 mg lidocaine bolus in prevention of propofol infusion pain. METHODS: One hundred sixty five ASA 1 or 2 patients scheduled for elective surgery under general anesthesia were classified in three groups. Group C: propofol TCI and remifentanil TCI was started at the same time (n = 55), group L: lidocaine 40 mg injection immediately prior to propofol TCI and remifentanil TCI (n = 55), group R: remifentanil TCI was started 90 seconds before propofol TCI (n = 55). Pain severity of propofol infusion was evaluated using a four-point scale (none, mild, moderate, severe). RESULTS: The incidence of pain in group R and group L was significantly lower than in group C. There was no significant difference between group R and group L. But the incidence of moderate and severe pain in group R was significantly lower than in group L (P < 0.05). CONCLUSIONS: Remifentanil TCI 90 seconds before propofol TCI reduces propofol infusion pain than propofol TCI and remifentanil TCI started at the same time. This protocol is considered to be more effective in alleviating moderate and severe pain than lidocaine.

Multiple Cancers in a Patient with Systemic Sclerosis and Aggravated Interstitial Lung Disease by Chemotherapy / 결핵및호흡기질환

Although the relationship between malignancy risk with systemic sclerosis (SSc) has been inconclusive, there are some previous studies for a positive correlation. Most patients with SSc have some degree of lung parenchymal involvement in the form of interstitial thickening and fibrosis. Interstitial lung disease is the most common pulmonary manifestation of SSc. Interstitial lung disease following chemotherapy (5-fluorouracil, leucovorin, and oxaliplatin [FOLFOX]) is an uncommon life-threatening complication and it is induced by oxaliplatin. We report a case of multiple cancers in a patient with SSc and aggravated interstitial lung disease by chemotherapy.

Massive pleural effusion in ovarian tumor patient during laparoscopic surgery / 대한마취과학회지

No abstract available.

Massive Bleeding Hemobilia Occurred in Patient with Hepatocellular Carcinoma / 대한소화기학회지

Massive bleeding hemobilia occurs rarely in patients with hepatocellular carcinoma (HCC) without any invasive procedure. Upper gastrointestinal bleeding in patient with cirrhosis and abdominal pain with progressive jaundice in patient with HCC were usually thought as variceal bleeding and HCC progression respectively. We experienced recently massive bleeding hemobilia in patient with HCC who was a 73-year old man and showed sudden abdominal pain, jaundice and hematochezia. He had alcoholic cirrhosis and history of variceal bleeding. One year ago, he was diagnosed as HCC and treated with transarterial chemoembolization periodically. Sudden right upper abdominal pain occurred then subsided with onset of hemotochezia. Computed tomography showed bile duct thrombosis spreading in the intrahepatic and extrahepatic ducts, while an ampulla of vater bleeding was observed during duodenoscopy. Hemobilia could be one of the causes of massive bleeding in patients with cirrhosis and HCC especially when they had sudden abdominal pain and abrupt elevation of bilirubin.

Bioequivalence of Two Erlotinib Formulations in Healthy Volunteers

BACKGROUND: Erlotinib is a tyrosine kinase inhibitor prescribed for the treatment of non-small cell lung cancer and pancreatic cancer. The aim of this study was to compare the safety and pharmacokinetics (PK) of a generic (test) formulation of erlotinib with those of a reference formulation in healthy volunteers. METHODS: A randomized, open-label, single-dose two-treatment, two-period, two-sequence, crossover study was conducted in Clinical Trials Center, Chungnam National University Hospital with 40 healthy men. Subjects orally received either one 150 mg tablet of the test or the corresponding dose of the reference, and crossover phases were separated by 14-day washout. Plasma samples were collected up to 72 hr post-dose. Plasma erlotinib concentrations were determined by liquid chromatography-tandem mass spectrometry. PK parameters were calculated by non-compartmental analysis. The safety was monitored throughout the study. RESULTS: A total of 21 cases of adverse events were reported. They are mild and relieved without an intervention. There was no serious adverse event. Median times to peak concentration of two formulations were 3.0. Means [SD] for peak concentration (Cmax) and area under the plasma concentration-time curve (AUC) of the test were 1,298 [346] microg/L and 25,318 [7,668] hrxmicrog/L. Those of the reference were 1,193 [378] microg/L and 24,853 [8,419] hrxmicrog/L. Geometric mean ratios (90% confidence intervals) for the test to the reference were 1.10 (1.02-1.18) for Cmax and 1.02 (0.97-1.09) for AUC. CONCLUSION: Two formulations were safe and well-tolerated. PK findings suggest that the test formulation is equivalent to the reference in terms of pharmacokinetics.

Spontaneous Remission of Hodgkin's Lymphoma in a Patient with Systemic Lupus Erythematosus after Withdrawal of Methotrexate

Methotrexate is often used in patients with systemic lupus erythematosus for effective disease controlsand steroid-sparing, and has been known to involve the development of lymphoproliferative disorders for patients with autoimmune diseases. We report a case of spontaneous regression of Epstein-Barr virus-positive methotrexate-associated Hodgkin's lymphoma in a 24-year-old woman with systemic lupus erythematosus. Following 6 months of treatment with low-dose methotrexate, the patient developed a neck mass in the right submandibular area. A computed tomography scan of the neck, chest and abdomen revealed multiple enlarged lymph nodes. Excisional biopsy of the neck masses confirmed infiltrations of malignant lymphoid cells that were positive for CD15, CD30, and Epstein-Barr virus-encoded RNA. Reduction of the mass was observed 3 weeks after withdrawing from the methotrexate treatment. At 7 months after initial presentation, computed tomography revealed near-complete regression of lymphadenopathy. After 30 months, the patient was still in complete clinical remission.

A Promising Treatment for Broncholith Removal Using Cryotherapy during Flexible Bronchosopy: Two Case Reports / 결핵및호흡기질환

Broncholiths are defined as calcified materials that occur in a tracheobronchial tree or in a cavity communicating with that. Broncholith has variable clinical features. The therapeutic options to remove broncholiths are so variable that clinicians need to select the most safe and effective methods by mass size, mobility, and location. As yet, there is no consistent guideline removing a broncholith. We report 2 successful cases of removing a fixed broncholith by flexible bronchoscopy guided cryoadhesion. With repeated technique of thawing and freezing with ryoprobe, we could extract the fixed broncholith safely. This method is promising as a way to remove broncholith in the future.

Rhabdomyolysis and Mild Kidney Injury in a Patient with Acute Hepatitis A / 영남의대학술지

A 48-year-old male visited the emergency room of the authors' hospital due to nausea, vomiting, and myalgia for four days. Acute hepatitis A was identified from the serologic marker of the hepatitis A virus. Mild elevation of the serum creatinine and creatinine phosphokinase (CPK) suggested rhabomyolysis, which was confirmed with the serum aldolase, myoglobin, and urine myoglobin. With supportive care, both the liver and renal functions were recovered gradually and fully. This case shows that rhabdomyolysis can be one of the mechanisms of renal complication in cases of acute symptomatic hepatitis A.

A Case of Small Bowel Intussusception Caused by Jejunal Hamartoma Confused as Hepatitis A in an Adult / 영남의대학술지

Intussusception in adult is a rare disease and laparotomy is usually considered because of the probability of malignancy. Especially with obstruction symptom or sign, it might be needed emergency operation. This case was a simultaneous development of small bowel intussusception and acute hepatitis A. The patient had abdominal pain and vomiting. Intitial laboratory examination with elevated aminotransferase revealed that the diagnosis was acute hepatitis. As managing acute hepatitis, the abdominal pain was not improved and the patient had tenderness on periumbilical area on physical examination. A jejunal intussusception with a lead point was proved on the abdominal computed tomography scan. Fortunately, symptom of intussusception was relieved while nulli per os (NPO) and intravenous hydration. After recovery of acute hepatitis, laparotomy was done. The lead point was 2.5x3.0 cm sized hamartoma. This was the case that the symptom of intussusception was confused with that of acute hepatitis.

A case of a fractured and impacted central venous chemoport in a patient with stomach cancer / 대한내과학회지

A central venous port catheter is widely used to administer fluids, chemotherapeutic agents, and parenteral nutrition; however, similar to other invasive procedures, it has numerous potential complications. Among them, distal migration of a fractured central venous port catheter is a rare complication. A 66-year-old man had a central venous port catheter implanted into the right subclavian vein for adjuvant stomach cancer chemotherapy and presented with an ulceration at the chemoport insertion site. While removing the port catheter, it fractured and the distal tip and migrated and impacted the annulus of the right atrium. The impacted port catheter was successfully removed through a femoral vein approach using a radiofrequency ablation catheter and a multi snare.

Morphological Characteristics and Intercellular Connections of Corneal Keratocytes

PURPOSE: To investigate the morphological characteristics of keratocytes and the interconnection of keratocytes with adjacent keratocytes using the flat preparation method and scanning electron microscopy with a frontal section of the human corneal stroma. METHODS: The thin, corneal collagen lamellae were carefully dissected from the cornea (n=7), which had been stained by the flat preparation method. The remaining tissue was fixed in 3% glutaraldehyde and observed by transmission electron microscopy following the frontal section. RESULTS: The flat preparation revealed the corneal fibroblasts between the lamellae of the collagen fibers and showed that the ramifying cellular processes of the keratocytes were in contact with the cytoplasmic processes or cell bodies of neighboring fibroblasts. Two types of discrete subpopulations of keratocytes were identified: a smaller, cellular type of keratocyte with spindle-shaped nucleus with heterochromatin, and a larger, cellular type with a large indented nucleus with relatively scanty cytoplasm. Collagen fibers ran parallel to each other toward the fenestration of the cytoplasmic wall of the keratocyte. CONCLUSIONS: These flat preparation method results showed that the keratocytes within the corneal stroma are interconnected with the adjacent keratocytes, which indicates the presence of a functional communicating network through the keratocyte circuits within the stroma. A smaller, cellular type of keratocyte with spindle-shaped nucleus was morphologically differentiated from a larger, cellular type with a large, indented nucleus by flat preparation and transmission electron microscopy.

The Cellular Characteristics of the Secondary Pupillary Membrane

PURPOSE: This study was performed to investigate the cellular characteristics of the secondary pupillary membrane. METHODS: The secondary pupillary membrane was removed from the anterior lens surface during cataract extraction from 2 patients with cataract associated with uveitis. Specimen from one patient was stained with hematoxylin-eosin with flat preparation method. Specimen from the other patient cultured for 1 and 2 weeks was observed with transmission electron microscopy. RESULTS: The flat preparation showed the neovascular membrane with pigment-laden cells. The cultured cells consisted of the well preserved vascular components which had the vascular endothelial cells and pericyte and pigment-laden cells lined by basement membrane on first week of culture. The iris pigment epithelial cell which contained the pigment granules within cytoplasm and lined by basement membrane were observed on second week of culture. CONCLUSIONS: These results suggest that the secondary pupillary membrane consists of vascular membrane and pigment epithelial cell of iris which is a major component of secondary pupillary membrane and secrets extracellular matrix.

Morphological Changes of Retinal Vessel Under Tissue Culture

PURPOSE: This study was performed to investigate the growth pattern of the retinal vessel including retinal vascular endothelial cell and pericyte. METHODS: The sensory retina was detached from the eyecup obtained from donor's eye. The retinal vessel which was separated from the sensory retina was cultured in tissue culture media for 2, 3 and 4 weeks separately and examined by transmission electron microscopy. RESULTS: On the second week of tissue culture, both the retinal vascular endothelial cells and pericyte were intact in morphology in nuclear and cytoplasmic pattern. Both cells were partially detached from the surrounding basement membrane. On the third week of tissue culture, the cytoplasm of the retinal vascular endothelial cells and pericyte were degenerated, whereas the vascular endothelial cell were intact in nuclear and cytoplasmic profiles which were still partially surrounded by the basement membrane. CONCLUSIONS: These findings suggest that the survivability of the retinal vascular endothelial cells and pericyte may be limited for 2 and 3 weeks, separatedly under the ordinary culture medium.

The Use of Ascorbic Acid after Excimer Laser Photo refractive Keratectomy in Rabbits

Polymorphonuclear leukocytes(PMNs) infiltrate to the wound site within a few hours after excimer laser photorefractive keratectomy(PRK). Oxygen free radicals produced by the PMNs may be injurious to the surrounding corneal tissues and also acts as an inflammatory mediator that deepen tissue damage. In this study we examined that the application of ascorbic acid would decrease corneal haze following excimer laser PRK. Excimer laser PRK was done in 9 rabbits (18 eyes). Ascorbic acid was injected subconjunctivally in one eye and BSS was injected in the opposite eye. The corneal epithelium re-surfaced by 2.6 +/- 0.5 days in the ascorbic acid treated group and by 2.7 +/- 0.7 days in the ESS injected group. Corneal hazes examined in postop 2wk, 4 wk, 6 wk, and 8 wk were 1.6 +/- 0.5, 1.4 +/- 0.5, 0.7 +/- 0.3, 0.5 +/- 0.2 in the ascorbic acid treated group and 2.1 +/- 0.6, 1.7 +/- 0.5, 1.1 +/- 0.3, 0.9 +/- 0.2 in the BSS injected group, respectively. These data suggest that ascorbic acid would decrease corneal haze after excimer laser PRK without significant complications.

Clinical Results of Phacoemulsification with Scleral Pocket Incision in Diabetic Patients

We compared the visual outcome after phacoemulsification through the scleral pocket incision between non-diabetic patients and diabetic patients, and studied the factors influencing the visual outcome and postoperative complications in diabetic patients. retrospectively. The subjects operated by one of the authors were composed of 277 non-diabetic patients (277 eyes) and 90 diabetic patients (113 eyes). An average of the best corrected visual acuities at postoperative 8 weeks was lower in diabetic patients than that in non-diabetic patients, but there was no statistically significant difference between diabetic patients who had no or background diabetic retinopathy and non-diabetic patients. In diabetic patients the visual outcome was significantly related with severity of diabetic retinopathy, duration of the diabetes, and insulin dependency, but not related with the rupture of posterior capsule during surgery. Among the complications there were posterior capsule rupture (10.6%), hyphema (7.8%), posterior capsular opacity (4.9%), and posterior synechiae (4.9%).

A Case of the Membranous Type of Prepyloric Gastric Atresia

No abstract available.

Clinical Study of Epilepsy in Children

No abstract available.