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Objectives: Up to 20% of HIV‐related focal brain lesion (FBL) diagnoses cannot be determined without invasive procedures. In such cases, brain biopsy is an important step in the evaluation algorithm. The aims of this study were to describe the clinical outcomes of patients with FBL, the proportion of diagnoses confirmed by brain biopsies and their aetiologies, and to analyse the proportion of patients in whom the biopsy motivated a change in therapeutic management. Methods: A retrospective cohort study was performed. The data from clinical records of patients with HIV‐related FBL admitted between January 2005 and December 2015 were reviewed. Results: A total of 137 patients were included in the study. The median age was 39 years [interquartile range (IQR) 33–44.5 years]. The median CD4 count was 54 cells/μL (IQR 21–124 cells/μL). Cerebral brain biopsy was performed in 21.16% of patients (29 of 137); 68.9% of these individuals (20 of 29) were diagnosed by histology, with results of central nervous system (CNS) lymphoma in 20.6% (six of 29), progressive multifocal leucoencephalopathy in 6.8% (two of 29), toxoplasmosis in 6.8% (two of 29), tuberculoma in 6.8% (two of 29), and other diagnoses in 27.6% (eight of 29). In nine patients, the histology was nonspecific. In 75.8% of patients (22 of 29), the result of the biopsy led to a change in the therapeutic management. We did not observe higher rates of mortality related to the procedure. Overall mortality at 30 and 90 days was similar in patients who were and were not biopsied. Conclusions: In this retrospective cohort study, cerebral biopsy was associated with significant adjustments in therapeutic management for a high percentage of patients. [ABSTRACT FROM AUTHOR]

The aim of this study was to develop a user-friendly checklist for critical appraisal of indirect comparisons of drugs, considering clinical, methodological/statistical and quality aspects, mainly to be applied in drug evaluation in the decision-making context. After conducting a review of the literature, we used group consensus to establish the key points of the checklist, focusing mainly on indirect comparisons, but including topics related to network meta-analysis or multiple treatment comparisons. The coordinating group elaborated the first draft, which was reviewed by external experts, re-evaluated by the coordinating group and finally assessed by 23 drug evaluation experts trained in indirect comparisons, who applied the checklist to one study. The Kappa index of agreement was calculated and the final checklist was developed by group consensus including the external experts. The checklist has two parts. The first consists of three eliminatory key questions while the second includes 17 items: 5 regarding quality, 5 regarding clinical issues and 7 dealing with methodology/statistics. The median kappa values of the 23 evaluations were 0.83 (range 0.67-0.93), 0.61 (0.54-0.91) and 0.36 (0.22-1) with regard to quality, clinical aspects and methodology/statistics, respectively. A structured checklist was developed to facilitate critical appraisal of key issues in indirect comparisons, including comments for assessing the consequences of its application to drug evaluation in the decision-making context. Agreement between reviewers in clinical and quality items was good, but weaker in methodology/statistics ones. [ABSTRACT FROM AUTHOR]

What is known and Objective Psoriatic arthritis is an autoimmune disease characterized by chronic inflammation of the skin and joints. Anti- TNF drugs reduce the severity of the disease in the long term. This study compares the efficacy and safety of adalimumab, etanercept, infliximab and golimumab in patients with psoriatic arthritis. Methods Direct comparison was based on a literature search of drug comparison studies, whereas indirect treatment comparison was based on phase III clinical trials with biological agents, involving similar populations and durations, and with the same outcome. ACR50 was taken as primary outcome for comparison, whereas ACR20 and ACR70 were used as secondary outcomes. Indirect comparisons were made using infliximab as the reference drug and the Bucher method. In calculating δ (the maximum acceptable difference as a clinical criterion of equivalence), use was made of half of the absolute risk reduction obtained in the meta-analysis of the clinical trials included in the indirect comparison ( ARR 32%; δ: 16%). The four anti- TNF drugs were also compared in relation to the secondary outcomes and adverse effects. Results and Discussion Reported direct and indirect comparisons of the four drugs did not include golimumab, and did not yield conclusive results. Four clinical trials - one for each drug studied - were identified. The estimated differences for the primary outcome, ACR50, between infliximab and the other drugs were adalimumab ( ARR 4%, 95% CI −9·5 to 17·5), etanercept ( ARR 4%, 95% CI −10·5 to 18·5) and golimumab ( ARR 9%, 95% CI −5·4 to 23·4). Likewise, there were no relevant differences between the drugs in relation to the secondary efficacy outcomes, except for etanercept, which was less effective in ACR70 response. For adverse reactions, there were also no significant differences except for injection site, reactions which were more frequent with etanercept, with a mean difference of 26% relative to infliximab. What is new and Conclusion No significant differences were found in ACR50 responses to the four drugs after 24 weeks. Injection-site reactions were more common with etanercept, but this was insufficient to invalidate the inference that clinically the four drugs can be regarded as clinically equivalent for the treatment of psoriatic arthritis. [ABSTRACT FROM AUTHOR]

To determine the most frequent urodynamic observations associated with bladder calculi, and to assess whether the presence of calculi alters these observations. Fifty patients with bladder stones were included in a prospective study in which two urodynamic tests were used, one at inclusion and another once the patient was stone- free after treatment by noninvasive methods (mainly extracorporeal shockwave lithotripsy). The results from the urodynamic evaluation with the stone in the bladder were: bladder outlet obstruction in 51%, detrusor overactivity in 68%, detrusor under-activity in 10%, and a normal study in 18%. There were no significant differences between the urodynamic study before or after treatment in maximum flow rate and postvoid residual volume, detrusor overactivity and detrusor pressure at maximum flow. Conversely to what has been accepted for years, bladder calculi are not always associated with bladder outlet obstruction and the urodynamic results are not influenced by the presence of bladder stones during the urodynamic testing. [ABSTRACT FROM AUTHOR]

: The objective of the present study was to evaluate the prelaryngeal position of the laryngeal mask airway (LMATM) in children, and to determine the influence of mask positioning on gastric insufflation and oropharyngeal air leakage. : A total of 100 children, 3–11 years old, scheduled for surgical procedures in the supine position under general anaesthesia were studied. After clinically satisfactory LMA placement, tidal volumes were increased stepwise until air entered the stomach, airway pressure exceeded 30 cmH2O, or air leakage from the mask seal prevented further increases in tidal volume. LMA position in relation to the laryngeal entrance was verified using a flexible bronchoscope. : The insertion of the LMA with a clinically satisfactory position was achieved in all patients at the first attempt. Gastric air insufflation occurred in five of 49 patients with malpositioned LMA. No incident of gastric air insufflation was observed in 51 patients with correctly positioned LMA. The minimum inspiratory pressure leading to mask leakage was 17 cmH2O for incorrectly positioned LMA, and 25 cmH2O for correctly positioned LMA. Clinically unrecognized LMA malposition was associated with a significantly increased incidence of either oropharyngeal leakage ( r = 0.59; P = 0.0001) or gastric insufflation ( r = 0.25; P = 0.01). : Clinically undetected LMA malpositioning is a significant risk factor for gastric air insufflation in children between 3 and 11 years, undergoing positive pressure ventilation, especially at inspiratory airway pressures above 17 cmH2O. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about an article in "Pediatric Allergy and Immunology" periodical regarding beta-lactam-positive allergy.

An abstract of the research paper "Correlation Between Prenatal Ultrasound Measurements and Newborn Outcome in the Free Loop of the Small Bowel in Gastroschisis," by J.C. Otero-Pinto and colleagues is presented.

Objectives: To determine the performance in learning clinical research methodology (CRM) by means of the Keller Plan (KP), to assess its impact on attitudes towards research (AR) and to estimate its acceptability., Design: An educational intervention trial was employed with control group (CG) and random assignment., Setting: The Family and Community Medicine Teaching Unit in Valencia, Spain, 1997., Subjects: Third-year family residents., Results: In the KP both specific written self-teaching material and interactive computer programme were used, focusing on the tutored resident, with compulsory assessments to continue. In the CG a conventional course was followed. Knowledge of CRM and the AR test (previously validated in another study) were measured at the start. Four tests of successive knowledge, time spent studying, tutorials, final AR test and acceptability were conducted. Non-parametric tests were used. Forty (89%) residents participated, 22 were assigned to KP and 18 to CG. Similar basic characteristics, with exception of AR test (medians 55 Keller, 58 control). KP knowledge tests significantly higher (P = < 0.05) than the CG (medians 101, 88) along with time spent studying (medians 53, 23.4 h). There were no significant differences in AR test, although there was an improvement in both groups, significant in KP but not in CG (median increase of 4.5 and 2). Nine residents used and positively assessed the computer programme. Better acceptability was obtained by the KP in overall evaluation, recommendation of the method and learning dynamic., Conclusions: The KP obtained better knowledge, motivated studying and was positively accepted.