Biomedical Sciences and Clinical Medicine

Comparative Analysis of the Efficacy and Safety of HIV/AIDS Treatment Strategies: A Comprehensive Review of Clinical Trial Data

2024-07-01T13:42:23+07:00

This comprehensive review and meta-analysis aimed to evaluate the comparative efficacy and safety of various antiretroviral (ARV) therapy regimens for HIV/AIDS treatment based on clinical trial data over 48 and 96 weeks. We conducted a systematic search across multiple databases, identifying 17 randomized controlled trials that met our inclusion criteria. These studies provided data on 12 different ARV regimens, focusing on integrase strand transfer inhibitor (INSTI)-based, non-nucleoside reverse transcriptase inhi-bitor (NNRTI)-based, and protease inhibitor (PI)-based treatments. Efficacy was measured by the percentage of participants achieving viral load suppression below 50 copies/mL, while safety was assessed through the incidence of serious adverse events. The analysis revealed significant variability in the efficacy and safety profiles of the ARV regimens studied. INSTI-based treatments, notably elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/TAF) and dolutegravir/lamivudine (DTG/3TC), demonstrated the highest levels of viral suppression, maintaining effectiveness at both the 48 and 96-week benchmarks. Notably, a weak positive correlation was identified between the efficacy of these treatments and the incidence of serious adverse events. Despite this correlation, the overall link between a regimen’s efficacy and its safety was found to be weak, highlighting the critical importance of tailoring HIV treatment to the individual patient’s needs and circumstances. The study underscores the importance of individualizing HIV/AIDS treatment strategies to optimize both efficacy and safety outcomes. While INSTI-based regimens show promise in terms of efficacy, the slightly increased risk of serious adverse events calls for careful consideration in treatment selection and monitoring. Future research should focus on longitudinal studies and the development of predictive models to further refine treatment strategies, helping ensure they are tailored to meet the individual needs of patients living with HIV/AIDS.

Perspectives on OncomiR and TSmiRs in Breast Cancer and Assessment of their Regulatory Network

2024-04-29T11:04:11+07:00

Breast cancer stands as a primary cause of mortality among women, urging the exploration of novel avenues for early detection. MicroRNAs (miRNAs) emerge as promising biomarkers, acting as both oncogenes and tumor suppressors, thus offering the potential for breakthroughs in early detection. Elevated levels of oncogenic miRNAs (OncomiRs) in cancer foster cell proliferation, migration, and metastasis by suppressing tumor suppressor genes. Inhibiting OncomiRs function presents a promising treatment strategy, where synthetic anti-miRs hinder OncomiRs binding to target RNAs, effectively suppressing cancer cell growth and metastasis. Conversely, decreased expression of Tumor Suppressor miRNAs (TSmiRs) in cancer facilitates malignancy progression by failing to suppress cancer-promoting genes. Circulating microRNAs (miRNAs) have gained considerable interest as promising biomarkers for breast cancer, owing to their distinct properties and involvement in cancer progression. An essential benefit of circulating miRNAs is their presence in bodily fluids like blood, serum, plasma, and breast milk. They exhibit remarkable stability within these fluids, safeguarded against degradation through encapsulation within extracellular vesicles or binding with proteins. This stability renders them appealing candidates for non-invasive biomarker identification. This article provides an overview of miRNA’s pivotal role in breast cancer and its clinical significance

Frequency of EGFR mutations and associated clinical factors in Thai patients with non-small cell lung cancer (NSCLC)

2024-05-23T14:20:57+07:00

Objective Understanding clinical factors related to epidermal growth factor receptor (EGFR) mutation in lung cancer patients is imperative for effective treatment planning. It is also crucial to recognize ethnic differences. Hence, studying the prevalence and types of EGFR mutations in Thai patients with non-small cell lung cancer (NSCLC) is essential. Investigating clinical factors influencing EGFR mutation detection remains critical.

Methods Etiognostic research with a retrospective observational cohort design collected clinical data from NSCLC patients undergoing EGFR molecu-lar testing using real-time PCR from November 1, 2017 to September 30, 2022. The relationship between smoking as well as other clinical factors of interest and the detection of EGFR mutation through regression were analyzed.

Results The EGFR mutation rate was 46.55%, with 108 cases detected out of 232 patients. EGFR mutation was detected in 63.41% of the never smoking group. Exon 19 deletion (51.85%) and exon 21 L858R mutation (36.11%) were the predominant types. Univariable regression analysis identified factors correlated with EGFR mutation detection, including female gender, non-smoker status, adenocarcinoma lung cancer type, and bone metastasis. A statistically significant reduction in EGFR mutation detection was observed in patients with squamous cell carcinoma lung cancer. Multivariable regression analysis confirmed non-smoker and adenocarcinoma lung cancer type as significant independent predictors of EGFR mutation detection (adjusted OR 2.84, 95%CI 1.20-6.74, p = 0.018) (adjusted OR 14.39, 95%CI 1.77-116.84, p = 0.013), respectively. The survival analysis results showed significant survival differences between stage 4 NSCLC patients with EGFR mutations and EGFR wild-type (median overall survival: 22.98 months vs 8.72 months, median survival time difference: 12.60 months, p < 0.001).

Conclusions Adenocarcinoma and non-smoker status represent significant factors associated with EGFR mutation. Nonetheless, performing an EGFR test before initiating treatment remains crucial as it enhances treatment precision and specificity.

Visual Outcomes Following Surgical Treatment of Pituitary Adenomas: Functional Versus Non-Functional

2024-06-19T09:01:40+07:00

Objective This study aims to compare visual outcomes following surgical resection of functional and non-functional pituitary adenoma.

Methods A retrospective observational study included 103 patients with pituitary adenoma who underwent tumor resection at Chiang Mai university hospital between January 2010 and December 2019. Basic characteristics, tumor specific data, hormonal status and neuro-ophthalmic data were collected and statistically analyzed to identify differences in visual outcomes between functional and non-functional tumors.

Results Between the 51 (49.50%) functional pituitary adenoma and 52 (50.50%) non-functional pituitary adenoma patients in this study, there were no differences in mean age at initial visit, sex, duration of onset, type of surgery, or adjunct radiotherapy. Initial visual acuity in logMAR in both the better and the worse eye, as well as the initial visual impairment

score (VIS) which represents a combination of visual acuity and visual field, showed no statistically significant differences. The final visual acuity of the better eye was significantly better in the functional group (0.08± 0.15) than in the non-functional group (0.22±0.47), with a p-value of 0.04. Similarly, the VIS score was significantly better in the functional group (18.37±19.85) than in the non-functional group (28.87±26.83), with a p-value of 0.028.

Conclusions Patients with functional pituitary adenomas have potentially better visual outcomes than those with non-functional pituitary adenomas after surgical resection.

Prevalence of and Risk Factors for Caregiver Burden in Palliative Care in Thailand

2024-05-07T10:12:15+07:00

Objective Caregivers are highly important in both conventional and palliative care. Their responsibilities, which include biological, psychological, and social aspects, can lead to stress and other complications. The objectives of this study were to determine (i) the prevalence of caregiver burden in palliative care and its severity, and (ii) risk factors associated with caregiver burden in palliative care settings.

Methods This cross-sectional study was conducted with palliative care patients and main caregivers in palliative care in both in- and out-patient departments of a hospital in Thailand. Baseline characteristics of caregivers and patients, including patients’ quality of life, caregivers’ self-efficacy, and caregiver burden were collected using Zarit Burden Interview (ZBI) scores. Linear regression was used to determine the association between caregiver burden and potential risk factors.

Results One hundred and two caregivers and their patients were included in the analysis. Caregivers’ mean age was 48.2±13.1 years. Most were female (77.5%) and married (65.7%). The mean age of the 102 patients of those caregivers was 64.9±13.8 years. The majority were female (57.8%) and most lived together with their caregiver (72.6%). The mean ZBI score of the caregivers was 13.4±13.9 of whom one-fourth had experienced caregiver’s burden (23.53%), with most having mild severity (17.7%). Factors negatively associated with ZBI scores were the patient’s quality of life (coefficient -0.46, 95% CI -0.89 to -0.04, p = 0.027) and the caregiver’s self-efficacy (coefficient -0.17, 95% CI -0.31 to -0.02, p = 0.033).

Conclusions The prevalence of caregiver burden in Thai palliative caregivers is relatively small. Greater caregiver self-efficacy and improved patient quality of life may help reduce caregiver burden. Assessment of caregiver burden level should be included as an integral aspect of the patient-care process.

Incidence of Cardiotoxicity Associated with The Use of Pegylated Liposomal Doxorubicin in Gynecologic Malignancies

2024-06-13T09:31:24+07:00

Objective This study aims to evaluate the incidence of cardiotoxicity in patients with gynecologic cancer undergoing pegylated liposomal doxorubicin (PLD) treatment and to identify risk factors for developing changes in the left ventricular ejection fraction (LVEF).

Methods A retrospective analysis was conducted on patients with gynecologic malignancies who had received PLD treatment at Phramongkutklao Hospital from January 2013 through December 2022. Cardiotoxicity was defined as a confirmed diagnosis of congestive heart failure or a decline in LVEF of 10% or more. Spearman’s correlation and mixed modeling were used to analyze the relationship between patient factors and MUGA variations.

Results A total of 34 patients were included in the study. The median number of PLD cycles was six, with a median cumulative dose of 240 mg. No patient experienced doxorubicin-induced cardiotoxicity. Among the 19 patients with available pre- and post-treatment LVEF measurements, no significant decline in LVEF was observed following PLD (MD 6.6%, p = 0.124). However, Spearman’s correlation analysis revealed a negative correlation between high cumulative PLD doses (exceeding 1,500 mg) and LVEF change (coefficient = -0.53, p < 0.001). Mixed model analysis suggested a potential association between higher body mass index (BMI) and decreased LVEF post-treatment (β = -1.21, p = 0.036), while diabetes may be associated with improved LVEF outcomes (β = 12.18, p = 0.033).

Conclusions There were no cases of cardiotoxicity after PLD treatment. A potential association between higher BMI and decreased LVEF was found. A high cumulative PLD dose is correlated negatively with LVEF change. Cardiac monitoring is recommended for selected patients, particularly those who are obese or have received cumulative PLD doses exceeding 1,500 mg.

Association Between use of a Single-Piston CPR Device in the Resuscitation Process and the Short-Term Survival of OHCA Patients

2024-05-02T09:44:25+07:00

Objective There is still a lack of evidence regarding the efficacy of using a single point piston without suction cup mechanical cardiopulmonary resuscitation (CPR) device in the resuscitation of out of hospital cardiac arrest (OHCA) cases in a moving ambulance setting. The aim of this study is to evaluate and compare short term survival rate return of spontaneous circulation (ROSC) of emergency medical service (EMS) delivered to OHCA patients receiving single point piston without a suction cup mechanical CPR device and manual CPR.

Methods This case control study was conducted using data on OHCA patients between 1 January 2017 and 31 March 2020 using part of the Pan-Asian Resuscitation Outcomes Study (PAROS) data. Cases were classified as ROSC or no ROSC. Logistic regression analysis was used for the multivariable analysis of the primary objective.

Results A total of 206 cases were included in this study, 68 ROSC cases and 138 no ROSC cases. The multivariable analysis found no significant difference in the ROSC rate of EMS delivered OHCA patients who received only manual CPR and patients who received the mechanical CPR either in the EMS (OR: 0.49, 95% confidence interval [CI]: 0.13-1.78) or the emergency department (ED) (AOR: 16.05, 95% confidence interval [CI]: 0.18-1435.78).

Conclusions The use of the single point piston without suction cup CPR device in OHCA cases was not found to be inferior in terms of ROSC rate compared with manual CPR. Also, potential benefits in a prehospital setting could be provided by the device use, e.g., fewer staff required in the EMS. Use of the device should be considered in appropriate situations.

Effect of Adding Dexmedetomidine to 0.5% Bupivacaine on Scalp Block on Intraoperative Hemodynamics During the First Hour of Surgery and Anesthetic Requirement in Intracranial Surgery

2024-07-09T08:11:05+07:00

Objective Dexmedetomidine has been used as a perineural local anesthetic (LA) adjunct to improve the quality of block and decrease opioid consumption. This study aims to determine the efficacy of adding dexmedetomidine to 0.5%bupivacaine on scalp block on hemodynamic responses during the first hour of surgery, intraoperative propofol and fentanyl doses, and analgesic requirements in the first 24 hours post-craniotomy.

Methods A prospective randomized controlled trial was conducted in forty-seven elective craniotomy patients receiving a scalp block with either 1 mcg/kg of dexmedetomidine (group D) or normal saline (group C) added to 0.5% bupivacaine (20 mL in total). Intraoperative blood pressure and heart rate at baseline and at 22 other time points during the first hour following the skin incision as well as the amount of intraoperative propofol and fentanyl and postoperative tramadol doses during the first 24 hours were collected and analyzed. The student t-test was used to compare means between groups, while repeated measure ANOVA with Bonferroni correction was used for comparing repeated means within each group. P-value less than 0.05 was considered statistically significant.

Results During skull pin fixation (T4), the mean arterial pressure (MAP) and heart rate (HR) of both groups increased from baseline, but there were no statistically significant differences between groups. During the first hour of the operation (T7–T22), both groups had lower MAPs than their baselines, and group D had lower MAPs than group C at all time points. Intraoperative doses of fentanyl (mcg/kg) and propofol (mg/kg) in group D were significantly lower than those in group C, p = 0.027 and p = 0.030, respectively.

Conclusions The addition of 1 mcg/kg dexmedetomidine tends to enhance the efficacy of scalp block with 0.5%bupivacaine in attenuating intraoperative hemodynamic responses during the first hour of surgery and reducing intraoperative fentanyl and propofol requirements during intracranial surgery.