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Indian Journal of Dermatology,... 2019Hidradenitis suppurativa is a chronic inflammatory condition that affects skin regions bearing apocrine glands. Although hidradenitis suppurativa is difficult to treat... (Meta-Analysis)
Meta-Analysis Review
Hidradenitis suppurativa is a chronic inflammatory condition that affects skin regions bearing apocrine glands. Although hidradenitis suppurativa is difficult to treat and cure, the currently available treatments are directed toward managing the lesions and associated symptoms. This review presents an evidence-based outline of the available treatment options. We searched four electronic databases and extracted data from retrieved studies for qualitative or quantitative analysis. Meta-analysis was conducted using the comprehensive meta-analysis software to generate pooled standardized mean differences or risk ratios. Numerous medical treatments are available for hidradenitis suppurativa such as antibiotics, retinoids, antiandrogens, immunosuppressive and anti-inflammatory agents and radiotherapy for early lesions. Adalimumab, an anti-tumor necrosis factor antibody, was superior to placebo in reducing Sartorius score (standardized mean difference = -0.32, confidence interval [-0.46, -0.18], P < 0.0001) and pain (risk ratio = 1.42, confidence interval [1.07, 1.9], P = 0.02), when given weekly (not every other week). Combination therapies (such as antibiotics and hyperbaric oxygen therapy) have been tested, which have shown promising results that are yet to be confirmed. Based on the quality of evidence, the most recommended treatments for hidradenitis suppurativa include adalimumab and laser therapy. Surgery (either by simple excision or complete local excision followed by skin graft) is the first choice for intractable disease presenting in the late stages. However, the evidence on most of these treatments is deficient and further randomized trials are needed to establish the most efficient therapies for hidradenitis suppurativa management.
Topics: Anti-Bacterial Agents; Combined Modality Therapy; Hidradenitis Suppurativa; Humans; Immunosuppressive Agents; Laser Therapy; Randomized Controlled Trials as Topic; Retinoids
PubMed: 30924446
DOI: 10.4103/ijdvl.IJDVL_69_18 -
Nefrologia 2020Physical exercise may offer multiple benefits to patients with chronic kidney disease (CKD). However, it was not traditionally recommended because of the possibility of... (Meta-Analysis)
Meta-Analysis
Physical exercise may offer multiple benefits to patients with chronic kidney disease (CKD). However, it was not traditionally recommended because of the possibility of impairing renal function and increasing proteinuria. The objective of this study is to review the clinical trials on physical exercise in patients with CKD and describe its effect on the progression of kidney disease and other factors associated. Randomized clinical trials (RCT) comparing an intervention that included an exercise component with a control group without physical exercise in non-dialysis patients with CKD from 2007 to 2018 in English and Spanish were included. PubMed, Scopus, Embase, Ovid (Medline) and PEDro databases were used for the search. Effects of physical exercise were summarized by the standardized mean difference (SMD). No differences were found in glomerular filtration rate or proteinuria between the intervention group and the control group: SMD -0.3 (P=.81); SMD 26.6 (P=.82). Positive effects were obtained on peak oxygen consumption: SMD 2.5 (P<.001), functional capacity: SMD 56.6 (P<.001), upper limb strength: SMD 6.8 (P<.001) and hemoglobin: SMD 0.3 (P=.003). An improvement on the quality of life was also evident using the KDQOL-36 survey: SMD 3.56 (P=.02) and the SF-36 survey: SMD 6.66 (P=.02). In conclusion, the practice of low-intensity physical exercise routinely has no negative impact on renal function. On the contrary, it improves aerobic and functional capacity, impacting positively on the quality of life.
Topics: Cardiovascular System; Combined Modality Therapy; Exercise; Exercise Therapy; Female; Glomerular Filtration Rate; Humans; Kidney; Male; Oxygen Consumption; Proteinuria; Quality of Life; Randomized Controlled Trials as Topic; Renal Insufficiency, Chronic; Renal Replacement Therapy; Treatment Outcome
PubMed: 32305232
DOI: 10.1016/j.nefro.2020.01.002 -
Phytomedicine : International Journal... Jul 2023Every day the skin is constantly exposed to several harmful factors that induce oxidative stress. When the cells are incapable to maintain the balance between... (Review)
Review
BACKGROUND
Every day the skin is constantly exposed to several harmful factors that induce oxidative stress. When the cells are incapable to maintain the balance between antioxidant defenses and reactive oxygen species, the skin no longer can keep its integrity and homeostasis. Chronic inflammation, premature skin aging, tissue damage, and immunosuppression are possible consequences induced by sustained exposure to environmental and endogenous reactive oxygen species. Skin immune and non-immune cells together with the microbiome are essential to efficiently trigger skin immune responses to stress. For this reason, an ever-increasing demand for novel molecules capable of modulating immune functions in the skin has risen the level of their development, particularly in the field of natural product-derived molecules.
PURPOSE
In this review, we explore different classes of molecules that showed evidence in modulate skin immune responses, as well as their target receptors and signaling pathways. Moreover, we describe the role of polyphenols, polysaccharides, fatty acids, peptides, and probiotics as possible treatments for skin conditions, including wound healing, infection, inflammation, allergies, and premature skin aging.
METHODS
Literature was searched, analyzed, and collected using databases, including PubMed, Science Direct, and Google Scholar. The search terms used included "Skin", "wound healing", "natural products", "skin microbiome", "immunomodulation", "anti-inflammatory", "antioxidant", "infection", "UV radiation", "polyphenols", "polysaccharides", "fatty acids", "plant oils", "peptides", "antimicrobial peptides", "probiotics", "atopic dermatitis", "psoriasis", "auto-immunity", "dry skin", "aging", etc., and several combinations of these keywords.
RESULTS
Natural products offer different solutions as possible treatments for several skin conditions. Significant antioxidant and anti-inflammatory activities were reported, followed by the ability to modulate immune functions in the skin. Several membrane-bound immune receptors in the skin recognize diverse types of natural-derived molecules, promoting different immune responses that can improve skin conditions.
CONCLUSION
Despite the increasing progress in drug discovery, several limiting factors need future clarification. Understanding the safety, biological activities, and precise mechanisms of action is a priority as well as the characterization of the active compounds responsible for that. This review provides directions for future studies in the development of new molecules with important pharmaceutical and cosmeceutical value.
Topics: Humans; Skin Aging; Reactive Oxygen Species; Biological Products; Antioxidants; Inflammation; Anti-Inflammatory Agents; Polyphenols; Peptides; Polysaccharides
PubMed: 37119762
DOI: 10.1016/j.phymed.2023.154824 -
European Journal of Physical and... Apr 2023The Schroth method is one of the most common physiotherapeutic scoliosis-specific exercises intervention applied in adolescent idiopathic scoliosis (AIS). This method... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The Schroth method is one of the most common physiotherapeutic scoliosis-specific exercises intervention applied in adolescent idiopathic scoliosis (AIS). This method consists of three-dimensional correction of the specific curve pattern of the patient using a combination of sensorimotor, postural, and corrective breathing exercises. The aim of this systematic review and meta-analysis was to analyse the effects of the Schroth method in isolation on Cobb angle, quality of life, and trunk rotation angle compared to no intervention or other conservative treatments in patients with AIS.
EVIDENCE ACQUISITION
PubMed, Physiotherapy Evidence Database, Scopus, Cochrane Library, and Web of Science databases were searched. Studies were included if they were randomized controlled trials that compared the effects of the Schroth method in isolation to conservative interventions or no intervention. The quality of the studies was assessed with the PEDro Scale, and the risk of bias with the Cochrane Collaboration tool. Two independent assessors extracted data through a standardized form. Meta-analyses were conducted using fixed or random effects models according to the heterogeneity assessed with I coefficient. Data on outcomes of interest were extracted by a researcher using RevMan 5.4 software.
EVIDENCE SYNTHESIS
A total of 317 studies were screened. Six were included in the meta-analysis involving 144 patients with AIS. The methodological quality of the included studies ranged from high to low. Schroth method in isolation showed significant improvements in Cobb angle (mean difference [MD] =-3.18º; 95% CI: -4.30, -2.07; I: 0%), quality of life (MD=0.28; 95% CI: 0.18, 0.38; I: 0%) and trunk rotation angle (MD=-2.12º; 95% CI: -3.44, -0.80; I: 71%) in the short-term.
CONCLUSIONS
The Schroth method in isolation is effective for reducing the Cobb angle and the trunk rotation angle and for improving the QoL in the short-term compared to no intervention or other conservative therapies in AIS, but the improvement in Cobb angle did not exceed the minimum clinically important difference.
Topics: Humans; Adolescent; Scoliosis; Quality of Life; Oxygen Isotopes; Exercise Therapy
PubMed: 36692412
DOI: 10.23736/S1973-9087.23.07654-2 -
Brazilian Journal of Physical Therapy 2017Physical exercise has been used to mitigate the metabolic effects of diabetes mellitus. (Review)
Review
BACKGROUND
Physical exercise has been used to mitigate the metabolic effects of diabetes mellitus.
OBJECTIVE
To evaluate the effect of resistance exercise when compared to aerobic exercise without insulin therapy on metabolic and clinical outcomes in patients with type 2 diabetes mellitus.
METHODS
Papers were searched on the databases MEDLINE/PubMed, CINAHL, SPORTDiscus, LILACS, and SCIELO, without language or date of publication limits. Clinical trials that compared resistance exercise to aerobic exercise in adults with type 2 diabetes mellitus who did not use insulin therapy were included. The quality of evidence and risk of bias were assessed using the GRADE system and the Cochrane Risk of Bias tool, respectively. Meta-analysis was also used, whenever possible. Two reviewers extracted the data independently. Eight eligible articles were included in this study, with a total of 336 individuals, with a mean age of 48-58 years. The protocols of aerobic and resistance exercise varied in duration from eight to 22 weeks, 30-60min/day, three to five times/week.
RESULTS
Overall the available evidence came from a very low quality of evidence and there was an increase in Maximal oxygen consumption (mean difference: -2.86; 95% CI: -3.90 to -1.81; random effect) for the resistance exercise and no difference was found in Glycated hemoglobin, Body mass index, High-density lipoprotein cholesterol, Low-density lipoprotein cholesterol, triglycerides, and total cholesterol.
CONCLUSIONS
Resistance exercise appears to be more effective in promoting an increase in Maximal oxygen consumption in protocols longer than 12 weeks and there is no difference in the control of glycemic and lipid levels between the two types of exercise.
Topics: Diabetes Mellitus, Type 2; Exercise; Exercise Therapy; Humans; Insulin; Oxygen Consumption; Resistance Training
PubMed: 28728958
DOI: 10.1016/j.bjpt.2017.06.004 -
American Journal of Nephrology 2019Inadequate dialysis, renal hypertension, and impaired exercise capacity are factors that affect the quality of life (QoL) and mortality of adults with end-stage renal... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Inadequate dialysis, renal hypertension, and impaired exercise capacity are factors that affect the quality of life (QoL) and mortality of adults with end-stage renal disease (ESRD) undergoing hemodialysis (HD). This systematic review provided valid evidence about the effect of exercise training on single-pool Kt/V (sp Kt/V), blood pressure, and peak uptake oxygen (VO2 peak).
METHOD
A systematic review and meta-analysis of published randomized controlled trials (RCTs) that evaluated the effects of no <8 weeks' exercise training on the physical fitness outcomes for adults with ESRD undergoing HD were accepted in this study.
RESULTS
Included 20 trials (677 participants) indicated that various exercise types improved aerobic capacity, walking capacity, and health-related QoL totally. Of note, aerobic exercise and combined exercise were the predominant exercise types.
CONCLUSION
Based on our evidence, aerobic exercise or combined exercise at least for 8 weeks to 12 months, 3 times weekly, will be beneficial to physical conditions of the patients with ESRD undergoing HD. The clinical staff can treat patients with the evidence above. Future studies need to provide more information basis for the construction of patient exercise system by adding various exercise combinations.
Topics: Blood Pressure; Exercise Therapy; Exercise Tolerance; Humans; Kidney Failure, Chronic; Oxygen Consumption; Physical Fitness; Quality of Life; Randomized Controlled Trials as Topic; Renal Dialysis; Resistance Training; Treatment Outcome
PubMed: 31454822
DOI: 10.1159/000502447 -
Biomolecules Aug 2021Hyperbaric oxygen therapy (HBOT) is commonly used as treatment in several diseases, such as non-healing chronic wounds, late radiation injuries and carbon monoxide... (Review)
Review
Hyperbaric oxygen therapy (HBOT) is commonly used as treatment in several diseases, such as non-healing chronic wounds, late radiation injuries and carbon monoxide poisoning. Ongoing research into HBOT has shown that preconditioning for surgery is a potential new treatment application, which may reduce complication rates and hospital stay. In this review, the effect of HBOT on oxidative stress, inflammation and angiogenesis is investigated to better understand the potential mechanisms underlying preconditioning for surgery using HBOT. A systematic search was conducted to retrieve studies measuring markers of oxidative stress, inflammation, or angiogenesis in humans. Analysis of the included studies showed that HBOT-induced oxidative stress reduces the concentrations of pro-inflammatory acute phase proteins, interleukins and cytokines and increases growth factors and other pro-angiogenesis cytokines. Several articles only noted this surge after the first HBOT session or for a short duration after each session. The anti-inflammatory status following HBOT may be mediated by hyperoxia interfering with NF-κB and IκBα. Further research into the effect of HBOT on inflammation and angiogenesis is needed to determine the implications of these findings for clinical practice.
Topics: Biomarkers; Humans; Hyperbaric Oxygenation; Inflammation; Neovascularization, Pathologic; Oxidative Stress
PubMed: 34439876
DOI: 10.3390/biom11081210 -
Respiratory Care Jan 2022Providing supplemental oxygen to hospitalized adults is a frequent practice and can be administered via a variety of devices. Oxygen therapy has evolved over the years,... (Review)
Review
Providing supplemental oxygen to hospitalized adults is a frequent practice and can be administered via a variety of devices. Oxygen therapy has evolved over the years, and clinicians should follow evidence-based practices to provide maximum benefit and avoid harm. This systematic review and subsequent clinical practice guidelines were developed to answer questions about oxygenation targets, monitoring, early initiation of high-flow oxygen (HFO), benefits of HFO compared to conventional oxygen therapy, and humidification of supplemental oxygen. Using a modification of the RAND/UCLA Appropriateness Method, 7 recommendations were developed to guide the delivery of supplemental oxygen to hospitalized adults: (1) aim for [Formula: see text] range of 94-98% for most hospitalized patients (88-92% for those with COPD), (2) the same [Formula: see text] range of 94-98% for critically ill patients, (3) promote early initiation of HFO, (4) consider HFO to avoid escalation to noninvasive ventilation, (5) consider HFO immediately postextubation to avoid re-intubation, (6) either HFO or conventional oxygen therapy may be used with patients who are immunocompromised, and (7) consider humidification for supplemental oxygen when flows > 4 L/min are used.
Topics: Humans; Adult; Oxygen; Oxygen Inhalation Therapy; Critical Care; Intubation; Noninvasive Ventilation
PubMed: 34728574
DOI: 10.4187/respcare.09294 -
International Journal of Chronic... 2022To evaluate the clinical efficacy of high-flow nasal oxygen therapy (HFNC) and non-invasive ventilation (NIV) in patients with acute exacerbation of chronic obstructive... (Meta-Analysis)
Meta-Analysis Review
High-Flow Nasal Cannula Oxygen Therapy versus Non-Invasive Ventilation for AECOPD Patients After Extubation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
OBJECTIVE
To evaluate the clinical efficacy of high-flow nasal oxygen therapy (HFNC) and non-invasive ventilation (NIV) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) after extubation.
RESEARCH METHODS
This systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statements. The primary outcome measures analyzed included: reintubation rate, mortality, complication rate, and ICU length of stay.
RESULTS
Eight studies were included, with a total of 612 subjects, including 297 in the HFNC group and 315 in the NIV group. The effect of HFNC and NIV on the reintubation rate of AECOPD patients after extubation, RR (1.49 [95% CI,0.95 to 2.33], P = 0.082). Subgroup analysis with or without hypercapnia according to the included AECOPD population, with hypercapnia, RR (0.69 [95% CI,0.33 to 1.44], P=0.317), without hypercapnia, RR (2.61 [95% CI,1.41 to 4.83], P=0.002). Mortality, RR (0.92 [95% CI,0.56 to 1.52], P = 0.752). ICU length of stay, MD (-0.44 [95% CI,-1.01 to 0.13], P = 0.132). Complication rate, RR (0.22 [95% CI,0.13 to 0.39], P = 0.000). After subgroup analysis, the reintubation rate of HFNC and NIV has no statistical difference in patients with hypercapnia, but NIV can significantly reduce the reintubation rate in patients without hypercapnia. In the outcome measures of complication rate, HFNC significantly reduced complication rate compared with NIV. In mortality and ICU length of stay, analysis results showed that HFNC and NIV were not statistically different.
CONCLUSION
According to the available evidence, the application of HFNC can be used as an alternative treatment for NIV after extubation in AECOPD patients with hypercapnia, but in the patients without hypercapnia, HFNC is less effective than NIV.
Topics: Airway Extubation; Cannula; Humans; Hypercapnia; Noninvasive Ventilation; Oxygen; Oxygen Inhalation Therapy; Pulmonary Disease, Chronic Obstructive; Randomized Controlled Trials as Topic; Respiratory Insufficiency
PubMed: 36065316
DOI: 10.2147/COPD.S375107 -
International Journal of Chronic... 2023This study aimed to evaluate the clinical outcomes of high-flow nasal cannula (HFNC) compared with conventional oxygen therapy (COT) in patients with hypercapnic chronic... (Meta-Analysis)
Meta-Analysis Review
Comparison of High-Flow Nasal Cannula with Conventional Oxygen Therapy in Patients with Hypercapnic Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.
PURPOSE
This study aimed to evaluate the clinical outcomes of high-flow nasal cannula (HFNC) compared with conventional oxygen therapy (COT) in patients with hypercapnic chronic obstructive pulmonary disease (COPD), including arterial partial pressure of carbon dioxide (PaCO), arterial partial pressure of oxygen (PaO), respiratory rate (RR), treatment failure, exacerbation rates, adverse events and comfort evaluation.
PATIENTS AND METHODS
PubMed, EMBASE and the Cochrane Library were retrieved from inception to September 30, 2022. Eligible trials were randomized controlled trials and crossover studies comparing HFNC and COT in hypercapnic COPD patients. Continuous variables were reported as mean and standard derivation and calculated by weighted mean differences (MD), while dichotomous variables were shown as frequency and proportion and calculated by odds ratio (OR), with the 95% confidence intervals (Cl). Statistical analysis was performed using RevMan 5.4 software.
RESULTS
Eight studies were included, five with acute hypercapnia and three with chronic hypercapnia. In acute hypercapnic COPD, short-term HFNC reduced PaCO (MD -1.55, 95% CI: -2.85 to -0.25, I² = 0%, p <0.05) and treatment failure (OR 0.54, 95% CI: 0.33 to 0.88, I² = 0%, p<0.05), but there were no significant differences in PaO (MD -0.36, 95% CI: -2.23 to 1.52, I² = 45%, p=0.71) and RR (MD -1.07, 95% CI: -2.44 to 0.29, I² = 72%, p=0.12). In chronic hypercapnic COPD, HFNC may reduce COPD exacerbation rates, but there was no advantage in improving PaCO (MD -1.21, 95% CI: -3.81 to 1.39, I² = 0%, p=0.36) and PaO (MD 2.81, 95% CI: -1.39 to 7.02, I² = 0%, p=0.19).
CONCLUSION
Compared with COT, short-term HFNC reduced PaCO and the need for escalating respiratory support in acute hypercapnic COPD, whereas long-term HFNC reduced COPD exacerbations rates in chronic hypercapnia. HFNC has great potential for treating hypercapnic COPD.
Topics: Humans; Pulmonary Disease, Chronic Obstructive; Oxygen; Hypercapnia; Cannula; Respiratory Insufficiency; Noninvasive Ventilation; Oxygen Inhalation Therapy; Randomized Controlled Trials as Topic
PubMed: 37215746
DOI: 10.2147/COPD.S402506