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European Respiratory Review : An... Jun 2021Inhaled corticosteroids (ICSs) are indicated for the prevention of exacerbations in COPD; however, a significant proportion of patients at low risk of exacerbations are... (Review)
Review
Inhaled corticosteroids (ICSs) are indicated for the prevention of exacerbations in COPD; however, a significant proportion of patients at low risk of exacerbations are treated with ICSs. We conducted a systematic review including a diversity of types of study designs and safety outcomes with the objective of describing the risk of adverse effects associated with the long-term use of ICSs in patients with COPD.A total of 90 references corresponding to 83 studies were included, including 26 randomised clinical trials (RCTs), 33 cohort studies, and 24 nested case-control (NCC) studies. Analysis of 19 RCTs showed that exposure to ICSs for ≥1 year increased the risk of pneumonia by 41% (risk ratio 1.41, 95% CI 1.23-1.61). Additionally, cohort and NCC studies showed an association between ICSs and risk of tuberculosis and mycobacterial disease. There was a strong association between ICS use and local disorders such as oral candidiasis and dysphonia. The association between ICSs and the risk of diabetes and fractures was less clear and appeared significant only at high doses of ICSs.Since most patients with COPD are elderly and with frequent comorbidities, an adequate risk-benefit balance is crucial for the indication of ICSs.
Topics: Administration, Inhalation; Adrenal Cortex Hormones; Aged; Drug Therapy, Combination; Humans; Pneumonia; Pulmonary Disease, Chronic Obstructive
PubMed: 34168063
DOI: 10.1183/16000617.0075-2021 -
JAMA Network Open May 2024Noninvasive brain stimulation (NIBS) interventions have been shown to be efficacious in several mental disorders, but the optimal dose stimulation parameters for each... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Noninvasive brain stimulation (NIBS) interventions have been shown to be efficacious in several mental disorders, but the optimal dose stimulation parameters for each disorder are unknown.
OBJECTIVE
To define NIBS dose stimulation parameters associated with the greatest efficacy in symptom improvement across mental disorders.
DATA SOURCES
Studies were drawn from an updated (to April 30, 2023) previous systematic review based on a search of PubMed, OVID, and Web of Knowledge.
STUDY SELECTION
Randomized clinical trials were selected that tested transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS) for any mental disorder in adults aged 18 years or older.
DATA EXTRACTION AND SYNTHESIS
Two authors independently extracted the data. A 1-stage dose-response meta-analysis using a random-effects model was performed. Sensitivity analyses were conducted to test robustness of the findings. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.
MAIN OUTCOMES AND MEASURES
The main outcome was the near-maximal effective doses of total pulses received for TMS and total current dose in coulombs for tDCS.
RESULTS
A total of 110 studies with 4820 participants (2659 men [61.4%]; mean [SD] age, 42.3 [8.8] years) were included. The following significant dose-response associations emerged with bell-shaped curves: (1) in schizophrenia, high-frequency (HF) TMS on the left dorsolateral prefrontal cortex (LDLPFC) for negative symptoms (χ2 = 9.35; df = 2; P = .009) and TMS on the left temporoparietal junction for resistant hallucinations (χ2 = 36.52; df = 2; P < .001); (2) in depression, HF-DLPFC TMS (χ2 = 14.49; df = 2; P < .001); (3) in treatment-resistant depression, LDLPFC tDCS (χ2 = 14.56; df = 2; P < .001); and (4) in substance use disorder, LDLPFC tDCS (χ2 = 33.63; df = 2; P < .001). The following significant dose-response associations emerged with plateaued or ascending curves: (1) in depression, low-frequency (LF) TMS on the right DLPFC (RDLPFC) with ascending curve (χ2 = 25.67; df = 2; P = .001); (2) for treatment-resistant depression, LF TMS on the bilateral DLPFC with ascending curve (χ2 = 5.86; df = 2; P = .004); (3) in obsessive-compulsive disorder, LF-RDLPFC TMS with ascending curve (χ2 = 20.65; df = 2; P < .001) and LF TMS on the orbitofrontal cortex with a plateaued curve (χ2 = 15.19; df = 2; P < .001); and (4) in posttraumatic stress disorder, LF-RDLPFC TMS with ascending curve (χ2 = 54.15; df = 2; P < .001). Sensitivity analyses confirmed the main findings.
CONCLUSIONS AND RELEVANCE
The study findings suggest that NIBS yields specific outcomes based on dose parameters across various mental disorders and brain regions. Clinicians should consider these dose parameters when prescribing NIBS. Additional research is needed to prospectively validate the findings in randomized, sham-controlled trials and explore how other parameters contribute to the observed dose-response association.
Topics: Humans; Transcranial Magnetic Stimulation; Transcranial Direct Current Stimulation; Mental Disorders; Adult; Male; Female; Middle Aged; Randomized Controlled Trials as Topic
PubMed: 38776083
DOI: 10.1001/jamanetworkopen.2024.12616 -
The Cochrane Database of Systematic... Mar 2016Specific treatments for influenza are limited to neuraminidase inhibitors and adamantanes. Corticosteroids show evidence of benefit in sepsis and related conditions,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Specific treatments for influenza are limited to neuraminidase inhibitors and adamantanes. Corticosteroids show evidence of benefit in sepsis and related conditions, most likely due to their anti-inflammatory and immunomodulatory properties. Although commonly prescribed for severe influenza, there is uncertainty over their potential benefit or harm.
OBJECTIVES
To systematically assess the effectiveness and potential adverse effects of corticosteroids as adjunctive therapy in the treatment of influenza, taking into account differences in timing and doses of corticosteroids.
SEARCH METHODS
We searched CENTRAL (2015, Issue 5), MEDLINE (1946 to June week 1, 2015), EMBASE (1974 to June 2015), CINAHL (1981 to June 2015), LILACS (1982 to June 2015), Web of Science (1985 to June 2015), abstracts from the last three years of major infectious disease and microbiology conferences, and references of included articles.
SELECTION CRITERIA
We included randomised controlled trials (RCTs), quasi-RCTs and observational studies that compared corticosteroid treatment with no corticosteroid treatment for influenza or influenza-like illness. We did not restrict studies by language of publication, influenza subtypes, clinical setting or age of participants. We selected eligible studies in two stages: sequential examination of title and abstract, followed by full text.
DATA COLLECTION AND ANALYSIS
Two pairs of review authors independently extracted data and assessed risk of bias. We pooled estimates of effect using random-effects meta-analysis models, where appropriate. We assessed heterogeneity using the I(2) statistic and assessed the quality of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.
MAIN RESULTS
We identified 19 eligible studies (3459 individuals), all observational; 13 studies (1917 individuals) were suitable for inclusion in the meta-analysis of mortality. Of these, 12 studied patients infected with 2009 influenza A H1N1 virus (H1N1pdm09). Risk of bias was greatest in the 'comparability domain' of the Newcastle-Ottawa scale, consistent with potential confounding by indication. Data specific to mortality were of very low quality. Reported doses of corticosteroids used were high and indications for their use were not well reported. On meta-analysis, corticosteroid therapy was associated with increased mortality (odds ratio (OR) 3.06, 95% confidence interval (CI) 1.58 to 5.92). Pooled subgroup analysis of adjusted estimates of mortality from four studies found a similar association (OR 2.82, 95% CI 1.61 to 4.92). Three studies reported greater odds of hospital-acquired infection related to corticosteroid therapy; all were unadjusted estimates and we graded the data as very low quality.
AUTHORS' CONCLUSIONS
We did not identify any completed RCTs of adjunctive corticosteroid therapy for treating influenza. The available evidence from observational studies is of very low quality with confounding by indication a major potential concern. Although we found that adjunctive corticosteroid therapy was associated with increased mortality, this result should be interpreted with caution. In the context of clinical trials of adjunctive corticosteroid therapy in sepsis and pneumonia that report improved outcomes, including decreased mortality, more high-quality research is needed (both RCTs and observational studies). Currently, we do not have sufficient evidence in this review to determine the effectiveness of corticosteroids for patients with influenza.
Topics: Adrenal Cortex Hormones; Chemotherapy, Adjuvant; Cross Infection; Humans; Influenza A Virus, H1N1 Subtype; Influenza, Human; Intensive Care Units; Observational Studies as Topic
PubMed: 26950335
DOI: 10.1002/14651858.CD010406.pub2 -
Neuropsychology Review Mar 2016Oppositional defiant disorder (ODD) and conduct disorder (CD) are common behavioural disorders in childhood and adolescence and are associated with brain abnormalities.... (Meta-Analysis)
Meta-Analysis Review
A Systematic Review and Meta-analysis of Neuroimaging in Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) Taking Attention-Deficit Hyperactivity Disorder (ADHD) Into Account.
Oppositional defiant disorder (ODD) and conduct disorder (CD) are common behavioural disorders in childhood and adolescence and are associated with brain abnormalities. This systematic review and meta-analysis investigates structural (sMRI) and functional MRI (fMRI) findings in individuals with ODD/CD with and without attention-deficit hyperactivity disorder (ADHD). Online databases were searched for controlled studies, resulting in 12 sMRI and 17 fMRI studies. In line with current models on ODD/CD, studies were classified in hot and cool executive functioning (EF). Both the meta-analytic and narrative reviews showed evidence of smaller brain structures and lower brain activity in individuals with ODD/CD in mainly hot EF-related areas: bilateral amygdala, bilateral insula, right striatum, left medial/superior frontal gyrus, and left precuneus. Evidence was present in both structural and functional studies, and irrespective of the presence of ADHD comorbidity. There is strong evidence that abnormalities in the amygdala are specific for ODD/CD as compared to ADHD, and correlational studies further support the association between abnormalities in the amygdala and ODD/CD symptoms. Besides the left precuneus, there was no evidence for abnormalities in typical cool EF related structures, such as the cerebellum and dorsolateral prefrontal cortex. Resulting areas are associated with emotion-processing, error-monitoring, problem-solving and self-control; areas associated with neurocognitive and behavioural deficits implicated in ODD/CD. Our findings confirm the involvement of hot, and to a smaller extent cool, EF associated brain areas in ODD/CD, and support an integrated model for ODD/CD (e.g. Blair, Development and Psychopathology, 17(3), 865-891, 2005).
Topics: Adolescent; Adult; Attention Deficit Disorder with Hyperactivity; Attention Deficit and Disruptive Behavior Disorders; Brain; Brain Mapping; Child; Conduct Disorder; Female; Humans; Magnetic Resonance Imaging; Male; Young Adult
PubMed: 26846227
DOI: 10.1007/s11065-015-9315-8 -
BMJ Open Jan 2016To establish which non-psychotropic medications have been assessed in relation to risk of suicide or attempted suicide in observational studies, document reported... (Review)
Review
OBJECTIVES
To establish which non-psychotropic medications have been assessed in relation to risk of suicide or attempted suicide in observational studies, document reported associations and consider study strengths and limitations.
DESIGN
Systematic review.
METHODS
Four databases (Embase, Medline, PsycINFO and International Pharmaceutical Abstracts) were searched from 1990 to June 2014, and reference lists of included articles were hand-searched. Case-control, cohort and case only studies which reported suicide or attempted suicide in association with any non-psychotropic medication were included.
OUTCOME MEASURES
The outcomes eligible for inclusion were suicide and attempted suicide, as defined by the authors of the included study.
RESULTS
Of 11,792 retrieved articles, 19 were eligible for inclusion. Five studies considered cardiovascular medication and antiepileptics; two considered leukotriene receptor antagonists, isotretinoin and corticosteroids; one assessed antibiotics and another assessed varenicline. An additional study compared multiple medications prescribed to suicide cases versus controls. There was marked heterogeneity in study design, outcome and exposure classification, and control for confounding factors; particularly comorbid mental and physical illness. No increased risk was associated with cardiovascular medications, but associations with other medications remained inconclusive and meta-analysis was inappropriate due to study heterogeneity.
CONCLUSIONS
Whether non-psychotropic medications are associated with increased risk of suicide or attempted suicide remains largely unknown. Robust identification of suicide outcomes and control of comorbidities could improve quantification of risk associated with non-psychotropic medication, beyond that conferred by underlying physical and mental illnesses.
Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Anticonvulsants; Cardiovascular Agents; Humans; Isotretinoin; Leukotriene Antagonists; Observational Studies as Topic; Prescription Drugs; Risk; Risk Factors; Suicide; Suicide, Attempted; Varenicline
PubMed: 26769782
DOI: 10.1136/bmjopen-2015-009074 -
The Cochrane Database of Systematic... Dec 2022Bronchopulmonary dysplasia (BPD), defined as oxygen dependence at 36 weeks' postmenstrual age (PMA), remains an important complication of prematurity. Pulmonary... (Review)
Review
BACKGROUND
Bronchopulmonary dysplasia (BPD), defined as oxygen dependence at 36 weeks' postmenstrual age (PMA), remains an important complication of prematurity. Pulmonary inflammation plays a central role in the pathogenesis of BPD. Attenuating pulmonary inflammation with postnatal systemic corticosteroids reduces the incidence of BPD in preterm infants but may be associated with an increased risk of adverse neurodevelopmental outcomes. Local administration of corticosteroids via inhalation may be an effective and safe alternative.
OBJECTIVES
To assess the benefits and harms of inhaled corticosteroids versus placebo, initiated between seven days of postnatal life and 36 weeks' postmenstrual age, to preterm infants at risk of developing bronchopulmonary dysplasia.
SEARCH METHODS
We searched CENTRAL, MEDLINE, Embase, CINAHL, and three trials registries to August 2022. We searched conference proceedings and the reference lists of retrieved articles for additional studies.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) comparing inhaled corticosteroids to placebo, started between seven days' postnatal age (PNA) and 36 weeks' PMA, in infants at risk of BPD. We excluded trials investigating systemic corticosteroids versus inhaled corticosteroids.
DATA COLLECTION AND ANALYSIS
We collected data on participant characteristics, trial methodology, and inhalation regimens. The primary outcomes were mortality, BPD, or both at 36 weeks' PMA. Secondary outcomes included short-term respiratory outcomes (mortality or BPD at 28 days' PNA, failure to extubate, total days of mechanical ventilation and oxygen use, and need for systemic corticosteroids) and adverse effects. We contacted the trial authors to verify the validity of extracted data and to request missing data. We analysed all data using Review Manager 5. Where possible, we reported the results of meta-analyses using risk ratios (RRs) and risk differences (RDs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes, along with their 95% confidence intervals (CIs). We analysed ventilated and non-ventilated participants separately. We used the GRADE approach to assess the certainty of the evidence.
MAIN RESULTS
We included seven trials involving 218 preterm infants in this review. We identified no new eligible studies in this update. The evidence is very uncertain regarding whether inhaled corticosteroids affects the combined outcome of mortality or BPD at 36 weeks' PMA (RR 1.10, 95% CI 0.74 to 1.63; RD 0.07, 95% CI -0.21 to 0.34; 1 study, 30 infants; very low-certainty) or its separate components: mortality (RR 3.00, 95% CI 0.35 to 25.78; RD 0.07, 95% CI -0.08 to 0.21; 3 studies, 61 infants; very low-certainty) and BPD (RR 1.00, 95% CI 0.59 to 1.70; RD 0.00, 95% CI -0.31 to 0.31; 1 study, 30 infants; very low-certainty) at 36 weeks' PMA. Inhaled corticosteroids may reduce the need for systemic corticosteroids, but the evidence is very uncertain (RR 0.51, 95% CI 0.26 to 1.00; RD -0.22, 95% CI -0.42 to -0.02; number needed to treat for an additional beneficial outcome 5, 95% CI 2 to 115; 4 studies, 74 infants; very low-certainty). There was a paucity of data on short-term and long-term adverse effects. Despite a low risk of bias in the individual studies, we considered the certainty of the evidence for all comparisons discussed above to be very low, because the studies had few participants, there was substantial clinical heterogeneity between studies, and only three studies reported the primary outcome of this review.
AUTHORS' CONCLUSIONS
Based on the available evidence, we do not know if inhaled corticosteroids initiated from seven days of life in preterm infants at risk of developing BPD reduces mortality or BPD at 36 weeks' PMA. There is a need for larger randomised placebo-controlled trials to establish the benefits and harms of inhaled corticosteroids.
Topics: Infant, Newborn; Infant; Humans; Bronchopulmonary Dysplasia; Glucocorticoids; Dexamethasone; Infant, Premature; Adrenal Cortex Hormones; Pneumonia; Oxygen
PubMed: 36521169
DOI: 10.1002/14651858.CD002311.pub5 -
EC Psychology and Psychiatry Mar 2023Post-stroke depression (PSD) is a mental health condition that can develop after a stroke, with a higher risk of death and negative outcomes. However, limited research...
BACKGROUND
Post-stroke depression (PSD) is a mental health condition that can develop after a stroke, with a higher risk of death and negative outcomes. However, limited research has explored how PSD incidence relates to brain locations in Chinese patients. This study aims to fill this gap by examining the link between PSD occurrence and brain lesion location, as well as the type of stroke experienced by the patient.
METHODS
We conducted a systematic search in databases to gather post-stroke depression literature published between January 1, 2015 and May 31, 2021. Following this, we performed a meta-analysis using RevMan to analyze the incidence of PSD associated with different brain regions and types of stroke separately.
RESULTS
We analyzed seven studies, with a total of 1604 participants. Our findings indicated that the incidence of PSD was higher when the stroke occurred in the left hemisphere compared to the right hemisphere (RevMan: Z = 8.93, P <0.001, OR = 2.69, 95% CI: 2.16-3.34, fixed model); PSD was more common when the stroke affected the cerebral cortex rather than the subcerebral cortex (RevMan: Z = 3.96, P <0.001, OR = 2.00, 95% CI: 1.42-2.81) and when it affected the anterior cortex compared to the posterior cortex (RevMan: Z = 3.85, P <0.001, OR = 1.89, 95% CI: 1.37-2.62). However, we did not find a significant difference in the occurrence of PSD between ischemic and hemorrhagic strokes (RevMan: Z = 0.62, P = 0.53, OR = 0.02, 95% CI: -0.05-0.09).
CONCLUSIONS
Our findings revealed a higher likelihood of PSD in the left hemisphere, specifically in the cerebral cortex and anterior region.
PubMed: 36913221
DOI: No ID Found -
Trends in Psychiatry and Psychotherapy 2015A growing body of evidence suggests that bipolar disorder (BD) is a progressive disease according to clinical, biochemical and neuroimaging findings. This study reviewed... (Review)
Review
INTRODUCTION
A growing body of evidence suggests that bipolar disorder (BD) is a progressive disease according to clinical, biochemical and neuroimaging findings. This study reviewed the literature on the relationship between specific biomarkers and BD stages.
METHODS
A comprehensive literature search of MEDLINE and PubMed was conducted to identify studies in English and Portuguese using the keywords biomarker, neurotrophic factors, inflammation, oxidative stress, neuroprogression and staging models cross-referenced with bipolar disorder.
RESULTS
Morphometric studies of patients with BD found neuroanatomic abnormalities, such as ventricular enlargement, grey matter loss in the hippocampus and cerebellum, volume decreases in the prefrontal cortex and variations in the size of the amygdala. Other studies demonstrated that serum concentrations of neurotrophic factors, inflammatory mediators and oxidative stress may be used as BD biomarkers.
CONCLUSIONS
The analysis of neurobiological changes associated with BD progression and activity may confirm the existence of BD biomarkers, which may be then included in staging models that will lead to improvements in treatment algorithms and more effective, individually tailored treatment regimens. Biomarkers may also be used to define early interventions to control disease progression.
Topics: Biomarkers; Bipolar Disorder; Disease Progression; Humans
PubMed: 25860561
DOI: 10.1590/2237-6089-2014-0002 -
Current Topics in Behavioral... 2022Drug addiction is a complex brain disorder that is characterized by craving, withdrawal, and relapse, which can be perpetuated by social stress. Stemming from an acute...
BACKGROUND
Drug addiction is a complex brain disorder that is characterized by craving, withdrawal, and relapse, which can be perpetuated by social stress. Stemming from an acute life event, chronic stress, or trauma in a social context, social stress has a major role in the initiation and trajectory of substance use. Preclinical literature shows that early life stress exposure and social isolation facilitate and enhance drug self-administration. Epidemiological evidence links childhood adversity to increased risk for drug use and demonstrates that cumulative stress experiences are predictive of substance use severity in a dose-dependent manner. Stress and drug use induce overlapping brain alterations leading to downregulation or deficits in brain reward circuitry, thereby resulting in greater sensitization to the rewarding properties of drugs. Though stress in the context of addiction has been studied at the neural level, a gap in our understanding of the neural underpinnings of social stress in humans remains.
METHODS
We conducted a systematic review of in vivo structural and functional neuroimaging studies to evaluate the neural processes associated with social stress in individuals with substance use disorder. Results were considered in relation to participants' history of social stress and with regard to the effects of social stress induced during the neuroimaging paradigm.
RESULTS
An exhaustive search yielded 21 studies that matched inclusion criteria. Social stress induces broad structural and functional neural effects in individuals with substance use disorder throughout their lifespan and across drug classes. A few patterns emerged across studies: (1) many of the brain regions altered in individuals who were exposed to chronic social stress and during acute stress induction have been implicated in addiction networks (including the prefrontal cortex, insula, hippocampus, and amygdala); (2) individuals with childhood maltreatment and substance use history had decreased gray matter or activation in regions of executive functioning (including the medial prefrontal cortex, orbitofrontal cortex, anterior cingulate cortex), the hippocampal complex, and the supplementary motor area; and (3) during stress-induction paradigms, activation in the anterior cingulate cortex, caudate, and amygdala was most commonly observed.
CONCLUSIONS/IMPLICATIONS
A distinct overlap is shown between social stress-related circuitry and addiction circuitry, particularly in brain regions implicated in drug-seeking, craving, and relapse. Given the few studies that have thoroughly investigated social stress, the evidence accumulated to date needs to be replicated and extended, particularly using research designs and methods that disentangle the effects of substance use from social stress. Future clinical studies can leverage this information to evaluate the impact of exposure to trauma or adverse life events within substance use research. Expanding knowledge in this emerging field could help clarify neural mechanisms underlying addiction risk and progression to guide causal-experimental inquiry and novel prevention and treatment strategies.
Topics: Behavior, Addictive; Brain; Humans; Magnetic Resonance Imaging; Recurrence; Stress, Psychological; Substance-Related Disorders
PubMed: 34971448
DOI: 10.1007/7854_2021_272 -
Brain Sciences May 2023Transcranial magnetic stimulation (TMS) has become a promising strategy for bipolar disorder (BD). This study reviews neuroimaging findings, indicating functional,... (Review)
Review
Transcranial magnetic stimulation (TMS) has become a promising strategy for bipolar disorder (BD). This study reviews neuroimaging findings, indicating functional, structural, and metabolic brain changes associated with TMS in BD. Web of Science, Embase, Medline, and Google Scholar were searched without any restrictions for studies investigating neuroimaging biomarkers, through structural magnetic resonance imaging (MRI), diffusion tensor imaging (DTI), functional MRI (fMRI), magnetic resonance spectroscopy (MRS), positron emission tomography (PET), and single photon emission computed tomography (SPECT), in association with response to TMS in patients with BD. Eleven studies were included (fMRI = 4, MRI = 1, PET = 3, SPECT = 2, and MRS = 1). Important fMRI predictors of response to repetitive TMS (rTMS) included higher connectivity of emotion regulation and executive control regions. Prominent MRI predictors included lower ventromedial prefrontal cortex connectivity and lower superior frontal and caudal middle frontal volumes. SPECT studies found hypoconnectivity of the uncus/parahippocampal cortex and right thalamus in non-responders. The post-rTMS changes using fMRI mostly showed increased connectivity among the areas neighboring the coil. Increased blood perfusion was reported post-rTMS in PET and SPECT studies. Treatment response comparison between unipolar depression and BD revealed almost equal responses. Neuroimaging evidence suggests various correlates of response to rTMS in BD, which needs to be further replicated in future studies.
PubMed: 37239273
DOI: 10.3390/brainsci13050801