The Roles of Electronic Health Records for Clinical Trials in Low- and Middle-Income Countries: Scoping Review.

BACKGROUND: Clinical trials are a crucial element in advancing medical knowledge and developing new treatments by establishing the evidence base for safety and therapeutic efficacy. However, the success of these trials depends on various factors, including trial design, project planning, research staff training, and adequate sample size. It is also crucial to recruit participants efficiently and retain them throughout the trial to ensure timely completion. OBJECTIVE: There is an increasing interest in using electronic health records (EHRs)-a widely adopted tool in clinical practice-for clinical trials. This scoping review aims to understand the use of EHR in supporting the conduct of clinical trials in low- and middle-income countries (LMICs) and to identify its strengths and limitations. METHODS: A comprehensive search was performed using 5 databases: MEDLINE, Embase, Scopus, Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature. We followed the latest version of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guideline to conduct this review. We included clinical trials that used EHR at any step, conducted a narrative synthesis of the included studies, and mapped the roles of EHRs into the life cycle of a clinical trial. RESULTS: A total of 30 studies met the inclusion criteria: 13 were randomized controlled trials, 3 were cluster randomized controlled trials, 12 were quasi-experimental studies, and 2 were feasibility pilot studies. Most of the studies addressed infectious diseases (15/30, 50%), with 80% (12/15) of them about HIV or AIDS and another 40% (12/30) focused on noncommunicable diseases. Our synthesis divided the roles of EHRs into 7 major categories: participant identification and recruitment (12/30, 40%), baseline information collection (6/30, 20%), intervention (8/30, 27%), fidelity assessment (2/30, 7%), primary outcome assessment (24/30, 80%), nonprimary outcome assessment (13/30, 43%), and extended follow-up (2/30, 7%). None of the studies used EHR for participant consent and randomization. CONCLUSIONS: Despite the enormous potential of EHRs to increase the effectiveness and efficiency of conducting clinical trials in LMICs, challenges remain. Continued exploration of the appropriate uses of EHRs by navigating their strengths and limitations to ensure fitness for use is necessary to better understand the most optimal uses of EHRs for conducting clinical trials in LMICs.

Cost-Effectiveness of Population Screening Programs for Cardiovascular Diseases and Diabetes in Low- and Middle-Income Countries: A Systematic Review.

Almost all low- and middle-income countries (LMICs) have instated a program to control and manage non-communicable diseases (NCDs). Population screening is an integral component of this strategy and requires a substantial chunk of investment. Therefore, testing the screening program for economic along with clinical effectiveness is essential. There is significant proof of the benefits of incorporating economic evidence in health decision-making globally, although evidence from LMICs in NCD prevention is scanty. This systematic review aims to consolidate and synthesize economic evidence of screening programs for cardiovascular diseases (CVD) and diabetes from LMICs. The study protocol is registered on PROSPERO (CRD42021275806). The review includes articles from English and Chinese languages. An initial search retrieved a total of 2,644 potentially relevant publications. Finally, 15 articles (13 English and 2 Chinese reports) were included and scrutinized in detail. We found 6 economic evaluations of interventions targeting cardiovascular diseases, 5 evaluations of diabetes interventions, and 4 were combined interventions, i.e., screening of diabetes and cardiovascular diseases. The study showcases numerous innovative screening programs that have been piloted, such as using mobile technology for screening, integrating non-communicable disease screening with existing communicable disease screening programs, and using community health workers for screening. Our review reveals that context is of utmost importance while considering any intervention, i.e., depending on the available resources, cost-effectiveness may vary-screening programs can be made universal or targeted just for the high-risk population.

Flexible or Robust Amorphous Photonic Crystals from Network-Forming Block Copolymers for Sensing Solvent Vapors.

Large-area and flexible amorphous photonic crystals (APCs) featuring interconnected network microstructures are fabricated using high-molecular-weight polystyrene- block-poly(methyl methacrylate) (PS-PMMA) block copolymers. Kinetically controlled microphase separation combining with synergistic weak incompatibility gives rise to short-range-order network microstructures, exhibiting noniridescent optical properties. Solubility-dependent solvatochromism with distinct responses to various organic solvent vapors is observed in the network-forming APC film. By taking advantage of photodegradation of the PMMA block, nanoporous network-forming films were prepared for subsequent template synthesis of robust SiO2- and TiO2-based APC films through sol-gel reaction. Consequently, refractive index contrast of the APC film was able to be manipulated, resulting in intensely enhanced reflectivity and increased response rate for detecting solvent vapor. With the integration of self-assembly and photolithography approaches, flexible and robust network-forming APC films with well-defined photopatterned textures are carried out. This can provide a novel means for the design of photopatterned organic or inorganic APC films for sensing solvent vapors.

Endothelial Cell Sensitization by Death Receptor Fractions of an Anti-Dengue Nonstructural Protein 1 Antibody Induced Plasma Leakage, Coagulopathy, and Mortality in Mice.

The mechanisms leading to the life-threatening dengue hemorrhagic fever (DHF) remain elusive. DHF preferentially occurs during secondary dengue infections, suggesting that aberrant immune responses are involved in its development. We previously demonstrated that the autoantibodies elicited by dengue virus (DENV) nonstructural protein 1 (NS1; anti-NS1 Igs) induce plasma leakage and mortality in mice with warfarinized anticoagulant suppression. However, the involved pathogenic Ig fractions of anti-NS1 Igs remain unclear. In this study, the autoreactive Igs in patients with DHF and in NS1-immunized rabbits crossreacted with TNF-related apoptosis-inducing ligand receptor 1 (death receptor [DR]4). Challenges with the DENV in a subcytotoxic dose sensitized endothelial cells to apoptosis. Treatments with the autoantibodies induced proapoptotic activities and suppressed the surface expression of endothelial anticoagulant thrombomodulin. Combined treatments comprising the DENV and DR4 affinity-purified fractions of anti-NS1 IgGs (anti-NS1-DR4 Ig), but not preimmune control IgGs, in subcytotoxic doses led to apoptosis in endothelial cells. Treatments with the anti-NS1-DR4 Ig led to plasma leakage, coagulopathy, and morality in mice with warfarinized anticoagulant suppression. These results suggest that DR4-induced endothelial cell sensitization through NS1-elicited autoantibodies exacerbates anticoagulant suppression, vascular injury, and plasma leakage. Detecting and blocking anti-DR Igs in patients may be novel strategies for managing severe DENV infection.

Effect of different treatment plans on irradiated small-bowel volume in gynecologic patients undergoing whole-pelvic irradiation.

To evaluate the effect of different treatment plans for whole-pelvic irradiation on small-bowel volumes (SBVs) in patients with gynecologic malignancies, 40 patients were enrolled in this study. Computed tomography (CT) simulations were performed, and the small bowel of each patient was outlined manually. Treatment plans with equal-weighted (EW) and non-equal-weighted (NEW) (70% in bilateral directions) techniques of four-field and intensity-modulated radiation therapy (IMRT) were performed. The V10-V100 represented the volume (cm³) at different levels of the prescribed doses (10-100%). The V10-V100 was compared among the different treatment planning techniques, and patients who were suitable for IMRT or NEW were identified. IMRT and NEW significantly reduced the V50-V100 and V40-V60 levels compared with EW, respectively. NEW caused a significant reduction in the V30-V60 levels in patients with a BMI ≥26 kg/m². Patients with IMRT demonstrated lower V70-V100 levels compared with those with NEW. In patients with a BMI ≥26 kg/m² or an age ≥55 years, lower V20-V50 levels were noted using NEW compared with IMRT. Treatment planning with larger weighting in the bilateral directions in four-field radiotherapy reduces the low-dose SBV in patients with gynecologic malignancies, especially in those with a high BMI or the elderly. IMRT effectively reduces high-dose SBV, especially in patients with a low BMI.

Patterned fabrication of single ZnO nanorods and measurement of their optoelectrical characteristics.

This work develops a new process of growing well ordered ZnO nanorods in large scale on the Si(111) substrate. Nanosphere lithography (NSL) was adopted to produce a matrix in an extensive area. A pattern with a controlled amount of gold was formed through the nanosphere mask. The ZnO nanorods were then grown on a patterned Au/Si substrate through a metal catalytic vapor-liquid-solid (VLS) process. The structure and characteristics of ZnO nanorods were investigated by XRD, SEM and TEM. The hexagonal nanorods were dominated at (0002) direction with a lattice constant of approximately 5.03 A. The optoelectronical properties were studied by PL emission spectroscopy. A strong UV emission at 380 nm was observed. The band gap of the single ZnO nanorod was directly measured to be 3.36 eV using a conductive AFM. The superiority of patterned ZnO nanorods indicates their great potential in field emission display arrays.

Immediate pars plana vitrectomy improves outcome in retained intravitreal lens fragments after phacoemulsification.

PURPOSE: To investigate the clinical features, visual acuity outcomes and the most appropriate intervention time in patients with retained lens fragments managed by pars plana vitrectomy. METHODS: This was a retrospective review of the records of 78 patients who underwent pars plana vitrectomy for retained lens fragments at the Tri-Service General Hospital from January 1, 2000, to December 31, 2006. RESULTS: The mean age of the patients was 70 years (range, 24-92 years). There were 40 men (51%) and 38 women (49%). The mean follow-up period after surgery was 13.8 months. Forty-five patients (58%) had vitrectomy within 1 day of phacoemulsification (group A), 22 (28%) within 1 week (group B) and 11 (14%) after more than 1 week (group C). No patients in group A developed complications, and 76% achieved a final visual acuity of 6/12 or better. In group B, all patients had elevated intraocular pressure, and 45% achieved a final visual acuity of 6/12 or better. In group C, all patients presented with corneal edema, moderate or severe uveitis, and elevated intraocular pressure. Of these patients, 27% had cystoid macular edema, 36% developed retinal detachment, and 27% had a final visual acuity of 6/12 or better. CONCLUSION: Pars plana vitrectomy performed immediately after cataract surgery for retained lens fragments is a viable option and may achieve a better visual outcome, with reduced risk of secondary glaucoma, retinal detachment or cystoid macular edema.

Optic disc hemorrhages in a patient with hemophilia A.

To report a hemophilia patient complicated with optic disc hemorrhages. A 13-year-old boy presented to our emergency room with a black shadow in the left eye for 1 day. The best-corrected visual acuity was 6/6 in both eyes. Peripapillary retinal and subretinal hemorrhages were found in the left eye. Result of the laboratory examination showed an extremely low level of coagulation factor VIII (1.9%). Factor VIII concentrate was given for 8 weeks. A follow-up 3 months later showed absorption of the hemorrhages, black shadow diminished, and the vision was 6/6.

Long-term corneal retention of trichomes from bamboo shoots.

PURPOSE: To describe a rare case of corneal injury by trichomes of bamboo shoots. METHODS: A 58-year-old woman rubbed her right eye after touching a bamboo shoot, not knowing that there were many trichomes adherent to her hands. Severe conjunctival congestion and chemosis developed immediately but subsided the next day without visual impairment. Many trichomes were incidentally found to be embedded in the subepithelial region of the cornea on a routine slit-lamp examination. Three days after partial removal of the trichomes under a microscope, the epithelium had healed completely. RESULTS: Histopathologic examination showed bamboo trichomes in the epithelial scraping without inflammation. CONCLUSIONS: Trichomes of bamboo shoots may affect and stay in the cornea without significant inflammation because of their inert nature.

Clinical outcomes of combined sutureless vitrectomy with triamcinolone stain to manage vitreous loss resulting from posterior capsule rupture during phacoemulsification.

PURPOSE: To investigate the efficacy of sutureless pars plana vitrectomy (PPV) combined with intracameral triamcinolone stain in the management of vitreous loss associated with phacoemulsification. SETTING: Department of Ophthalmology, Tri-Service General Hospital, Taipei, Taiwan, Republic of China. METHODS: This retrospective review comprised the charts of 21 patients who had sutureless PPV combined with intracameral triamcinolone stain to manage vitreous loss resulting from posterior capsule rupture during phacoemulsification. The charts were analyzed for type of cataract, posterior segment pathology, methods of anesthesia, intraocular lens (IOL) placement, postoperative visual acuity, intraocular pressure, and complications. Additional outcome measurements were duration of the surgical procedures, period of postoperative corneal edema, and time to achieve stable vision. RESULTS: Excluding 2 eyes with preexisting conditions, 18 of 19 eyes (94.7%) had a final best corrected visual acuity (BCVA) of 20/40 or better and 42.1% (8/19) had a final BCVA of 20/20 or better. The mean duration of the surgery was 25.3 minutes (range 16 to 40 minutes). Corneal edema was noted in 12 eyes (57.1%) 3 days postoperatively and 3 eyes (14.3%) at 7 days. Eleven eyes (52.4%) had stable vision at 1 week, and 16 eyes (76.2%) had stable vision within 1 month postoperatively. Four eyes (19.0%) had postoperative complications that included a displaced IOL in 3 eyes (14.3%) and cystoid macular edema in 1 eye (4.8%). CONCLUSIONS: Self-sealing, sutureless PPV combined with intracameral triamcinolone stain was a safe, reliable adjunct to manage vitreous loss during phacoemulsification. The surgery led to rapid visual recovery.