-
Viruses Aug 2023Antiretroviral therapies (ARTs) have revolutionized the management of human immunodeficiency virus (HIV) infection, significantly improved patient outcomes, and reduced... (Review)
Review
Antiretroviral therapies (ARTs) have revolutionized the management of human immunodeficiency virus (HIV) infection, significantly improved patient outcomes, and reduced the mortality rate and incidence of acquired immunodeficiency syndrome (AIDS). However, despite the remarkable efficacy of ART, virologic failure remains a challenge in the long-term management of HIV-infected individuals. Virologic failure refers to the persistent detectable viral load in patients receiving ART, indicating an incomplete suppression of HIV replication. It can occur due to various factors, including poor medication adherence, drug resistance, suboptimal drug concentrations, drug interactions, and viral factors such as the emergence of drug-resistant strains. In recent years, extensive efforts have been made to understand and address virologic failure in order to optimize treatment outcomes. Strategies to prevent and manage virologic failure include improving treatment adherence through patient education, counselling, and supportive interventions. In addition, the regular monitoring of viral load and resistance testing enables the early detection of treatment failure and facilitates timely adjustments in ART regimens. Thus, the development of novel antiretroviral agents with improved potency, tolerability, and resistance profiles offers new options for patients experiencing virologic failure. However, new treatment options would also face virologic failure if not managed appropriately. A solution to virologic failure requires a comprehensive approach that combines individualized patient care, robust monitoring, and access to a range of antiretroviral drugs.
Topics: Humans; Acquired Immunodeficiency Syndrome; HIV Infections; Anti-Retroviral Agents; Medication Adherence; Treatment Failure
PubMed: 37632074
DOI: 10.3390/v15081732 -
Clinics and Practice Nov 2023Breast cancer affects almost 1.5 million women worldwide below the age of 45 years each year. Many of these women will be advised to undergo adjuvant chemotherapy to... (Review)
Review
INTRODUCTION
Breast cancer affects almost 1.5 million women worldwide below the age of 45 years each year. Many of these women will be advised to undergo adjuvant chemotherapy to minimize the risk of death or recurrence of the tumor. For these patients, chemotherapy is a known cause of infertility, as it can damage primordial follicles, which can lead to early menopause or premature ovarian insufficiency. This systematic review aims to synthesize the current evidence of the most suitable treatments for fertility preservation.
METHODOLOGY
This review was performed following the PRISMA guidelines. The authors conducted an extensive search from the last 15 years. Relevant studies were pursued in PubMed, Embase, and the Cochrane Library up until 31 July 2023. A total of seven eligible studies were identified.
RESULTS
From the reviewed literature, ovarian suppression with gonadotropin-releasing hormone agonists showed promising results in preserving fertility for breast cancer patients undergoing chemotherapy. Additionally, oocyte and embryo cryopreservation demonstrated successful outcomes, with embryo cryopreservation being the most effective option. Notably, the slow-freezing and vitrification methods were both effective in preserving embryos, with vitrification showing superior results in clinical-assisted reproductive technologies. Ovarian tissue cryopreservation emerged as a viable option for prepubertal girls and those unable to undergo conventional ovarian stimulation. The potential of in vitro maturation (IVM) as an alternative method presents a promising avenue for future fertility preservation research.
DISCUSSION
The most suitable treatments for fertility preservation in young patients is the temporary suppression with luteinizing hormone-releasing analogs, while the patient undergoes chemotherapy and cryopreservation. For cryopreservation, the physicians might deem it necessary to either cryopreserve ovarian tissue taken from the patient before any treatment or cryopreserve embryos/oocytes. Cryopreservation of oocytes and/or embryos is the most effective solution for fertility preservation in women of reproductive age, who have a sufficient ovarian reserve and are diagnosed with breast cancer, regardless of the histological type of the tumor. Because approximately 50% of young breast cancer patients are interested in becoming pregnant right after completion of therapy, the evolution and development of fertility preservation techniques promise to be very exciting.
PubMed: 37987428
DOI: 10.3390/clinpract13060127 -
Animals : An Open Access Journal From... Dec 2023The use of sensors to analyze behavior in sheep has gained increasing attention in scientific research. This systematic review aims to provide an overview of the sensors... (Review)
Review
The use of sensors to analyze behavior in sheep has gained increasing attention in scientific research. This systematic review aims to provide an overview of the sensors developed and used to detect rumination behavior in sheep in scientific research. Moreover, this overview provides details of the sensors that are currently commercially available and describes their suitability for sheep based on the information provided in the literature found. Furthermore, this overview lists the best sensor performances in terms of achieved accuracy, sensitivity, precision, and specificity in rumination detection, detailing, when applicable, the sensor position and epoch settings that were used to achieve the best results. Challenges and areas for future research and development are also identified. A search strategy was implemented in the databases PubMed, Web of Science, and Livivo, yielding a total of 935 articles. After reviewing the summaries of 57 articles remaining following filtration (exclusion) of repeated and unsuitable articles, 17 articles fully met the pre-established criteria (peer-reviewed; published between 2012 and 2023 in English or German; with a particular focus on sensors detecting rumination in sheep) and were included in this review. The guidelines outlined in the PRISMA 2020 methodology were followed. The results indicate that sensor-based systems have been utilized to monitor and analyze rumination behavior, among other behaviors. Notably, none of the sensors identified in this review were specifically designed for sheep. In order to meet the specific needs of sheep, a customized sensor solution is necessary. Additionally, further investigation of the optimal sensor position and epoch settings is necessary. Implications: The utilization of such sensors has significant implications for improving sheep welfare and enhancing our knowledge of their behavior in various contexts.
PubMed: 38136794
DOI: 10.3390/ani13243756 -
Archives of Gynecology and Obstetrics Jan 2024Interest gaps between public and private umbilical cord blood banks have led to the introduction of hybrid banking options. Hybrid models combine features of private and... (Review)
Review
PURPOSE
Interest gaps between public and private umbilical cord blood banks have led to the introduction of hybrid banking options. Hybrid models combine features of private and public banks as well as interests of parents, children and of patients, in order to find an optimized solution. While several different models of hybrid banks exist, there is a lack of literature about this novel model of cord blood stem cell banking. Therefore, the aim of this literature review is to assess different options of umbilical cord blood banking and whether hybrid banking could be a valuable alternative to the existing public and private cord blood banking models.
METHODS
We performed a systematic literature search, using five main databases. Five hybrid models regarding their advantages as well as their challenges are discussed in this review.
RESULTS
We found that a wealth of literature exists about public cord blood banking, while private and hybrid banking are understudied. Different modalities of hybrid cord blood banking are being described in several publications, providing the basis to assess different advantages and disadvantages as well as practicability.
CONCLUSION
Hybrid banks, especially the sequential model, seem to have potential as an alternative to the existing banking models worldwide. A previously conducted survey among pregnant women showed a preference for hybrid banking, if such an option was available. Nevertheless, opinions among stakeholders differ and more research is needed to evaluate, if hybrid banking provides the expected benefits.
Topics: Child; Female; Humans; Pregnancy; Fetal Blood; Blood Banking; Blood Banks; Pregnant Women; Surveys and Questionnaires
PubMed: 37093267
DOI: 10.1007/s00404-023-07003-x -
Cureus Mar 2024COVID-19, also known as coronavirus disease 2019, is an extremely contagious viral sickness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).... (Review)
Review
COVID-19, also known as coronavirus disease 2019, is an extremely contagious viral sickness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). After the first cases of this primarily respiratory viral illness were recorded in Wuhan, Hubei Province, China, in late December 2019, SARS-CoV-2 rapidly disseminated across the globe. Consequently, on March 11, 2020, the World Health Organization (WHO) declared it a global pandemic. The rapid spread of the COVID-19 virus, coupled with subsequent lockdowns and social distancing measures, profoundly disrupted traditional healthcare delivery systems. Amidst the COVID-19 pandemic, telemedicine emerged as a pivotal solution for delivering healthcare services while minimizing exposure to the virus. This study aims to assess patient and provider satisfaction with telemedicine during this unprecedented period. A systematic literature search was conducted on PubMed and Google Scholar using specific MeSH terms and Preferred Reporting Items for Systematic Literature Reviews and Meta-Analyses (PRISMA) guidelines to summarize patient and provider satisfaction concerning telemedicine using all the facts, evidence, and published literature. The analysis showed that although providers were generally satisfied with telemedicine, they were less satisfied than patients due to technical issues and difficulties transmitting documents. Patients reported high satisfaction with telemedicine, citing convenience and cost savings as major benefits. However, a lack of provider compensation was identified as a potential barrier to adoption. Most providers believed that telemedicine was only necessary in emergencies while a few recognized its potential for routine care. The study concludes that telemedicine has the potential to improve healthcare access and efficiency, but more research is needed to address technical and reimbursement issues and to determine the appropriate scope of telemedicine use. Overall, the findings of this study can inform future healthcare policies and regulations to ensure that telemedicine is used effectively and to the satisfaction of both patients and providers.
PubMed: 38628988
DOI: 10.7759/cureus.56308 -
Cureus Sep 2023Blockchain technology has gained attention as a potential solution for improving data security, privacy, and interoperability in various industries, including... (Review)
Review
Blockchain technology has gained attention as a potential solution for improving data security, privacy, and interoperability in various industries, including healthcare. In the field of dentistry, the implementation of blockchain holds promise for transforming dental practice and management. However, a comprehensive evaluation of the existing literature regarding the implementation of blockchain technology in dental practice is lacking. This systematic review aimed to assess the current evidence on the implementation of blockchain technology in dental practice and management. A systematic literature search was conducted using major databases to identify relevant studies. The search strategy included keywords related to blockchain technology and dentistry. The investigation was performed as per the PRISMA guidelines. Studies reporting on the implementation, adoption, and outcomes of blockchain technology in dental practice and management were included. Quality assessment and data extraction were performed following predefined criteria. The initial search yielded a multitude of articles, and after applying the inclusion and exclusion criteria, six studies were included in the systematic review. The studies explored various aspects of blockchain technology implementation in dental practice, including data security, interoperability, supply chain management, and patient consent management. Furthermore, the use of blockchain-based systems showed potential benefits in enhancing supply chain management efficiency and patient consent authentication. This systematic review provided insights into the current state of blockchain technology implementation in dental practice and management. The findings suggested that blockchain technology has the potential to enhance data security, privacy, and interoperability in dental practices. However, further research and real-world implementation studies are needed to fully understand the impact of blockchain technology on dental practice and to address the existing challenges.
PubMed: 37868487
DOI: 10.7759/cureus.45512 -
Neurospine Sep 2023Cervical myelopathy (CM) describes the compressive cervical spinal cord state, often accompanied by serious clinical condition, by herniated disc or hypertrophied spurs...
Clinical Effectiveness of Artificial Disc Replacement in Comparison With Anterior Cervical Discectomy and Fusion in the Patients With Cervical Myelopathy: Systematic Review and Meta-analysis.
OBJECTIVE
Cervical myelopathy (CM) describes the compressive cervical spinal cord state, often accompanied by serious clinical condition, by herniated disc or hypertrophied spurs or ligament. Anterior cervical discectomy and fusion (ACDF) has been frequently employed as conventional surgical solution for this CM despite its inherent biomechanical handicap. Alternatively, an artificial disc replacement (ADR) preserves cervical motion while still decompressing the spinal canal and neural foramen. This analysis elaborated to clarify the potential benefits of ADR application to CM over ACDF from the conglomerated results of the past references.
METHODS
A literature search was performed using MEDLINE, Embase, Cochrane review, and KMbase databases from the studies published until March 2023. Six studies (3 randomized controlled study [RCTs] and 3 non-RCTs) were included in a qualitative and quantitative synthesis. Data were extracted and analyzed using a random effects model to obtain effect size and its statistical significance. Quality assessment and evidence level were established in accordance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology.
RESULTS
Among 6 studies, 2 studies showed that ADR group achieved significantly better clinical improvement than the ACDF group, while the rest 4 studies revealed no significant difference. A meta-analysis showed better clinical outcomes with or without statistical significance. The level of evidence was low because of inconsistency and imprecision.
CONCLUSION
ADR was superior or at least, not inferior to ACDF in terms of functional recovery. However, its application to the CM patients is merely empowered with weak strength due to low level of evidence.
PubMed: 37798997
DOI: 10.14245/ns.2346498.249 -
Frontiers in Psychiatry 2024To date, only one systematic review and meta-analysis of randomized controlled trials (RCTs) has evaluated the effect of neurofeedback in PTSD, which included only four...
BACKGROUND
To date, only one systematic review and meta-analysis of randomized controlled trials (RCTs) has evaluated the effect of neurofeedback in PTSD, which included only four studies and found an uncertainty of the effect of EEG-NF on PTSD symptoms. This meta-analysis is an update considering that numerous studies have since been published. Additionally, more recent studies have included fMRI-NF as well as fMRI-guided or -inspired EEG NF.
METHODS
Systematic literature searches for RCTs were conducted in three online databases. Additional hand searches of each study identified and of systematic reviews and meta-analyses published were also undertaken. Outcomes evaluated the effect of neurofeedback vs. a control (active, sham, and waiting list) on their effects in reducing PTSD symptoms using various health instruments. Meta-analytical methods used were inverse variance random-effects models measuring both mean and standardized mean differences. Quality and certainty of the evidence were assessed using GRADE. Adverse events were also evaluated.
RESULTS
A total of 17 studies were identified evaluating a total of 628 patients. There were 10 studies used in the meta-analysis. Results from all studies identified favored neurofeedback's effect on reducing PTSD symptoms including BDI pretest-posttest [mean difference (MD): 8.30 (95% CI: 3.09 to 13.52; P = 0.002; = 0%)]; BDI pretest-follow-up (MD: 8.75 (95% CI: 3.53 to 13.97; P < 0.00001; = 0%); CAPS-5 pretest-posttest [MD: 7.01 (95% CI: 1.36 to 12.66; P = 0.02; = 86%)]; CAPS-5 pretest-follow-up (MD: 10 (95% CI: 1.29 to 21.29; P = 0.006; = 77%); PCL-5 pretest-posttest (MD: 7.14 (95% CI: 3.08 to 11.2; P = 0.0006; = 0%); PCL-5 pretest-follow-up (MD: 14.95 (95% CI: 7.95 to 21.96; P < 0.0001; = 0%). Other studies reported improvements using various other instruments. GRADE assessments of CAPS, PCL, and BDI demonstrated a moderate/high level in the quality of the evidence that NF has a positive clinical effect.
CONCLUSION
Based on newer published studies and the outcomes measured, NF has demonstrated a clinically meaningful effect size, with an increased effect size at follow-up. This clinically meaningful effect appears to be driven by newer fMRI-guided NF and deeper brain derivates of it.
PubMed: 38577405
DOI: 10.3389/fpsyt.2024.1323485 -
Sensors (Basel, Switzerland) Mar 2024Data from the Internet of Things (IoT) enables the design of new business models and services that improve user experience and satisfaction. These data serve as... (Review)
Review
Data from the Internet of Things (IoT) enables the design of new business models and services that improve user experience and satisfaction. These data serve as important information sources for many domains, including disaster management, biosurveillance, smart cities, and smart health, among others. However, this scenario involves the collection of personal data, raising new challenges related to data privacy protection. Therefore, we aim to provide state-of-the-art information regarding privacy issues in the context of IoT, with a particular focus on findings that utilize the Personal Data Store (PDS) as a viable solution for these concerns. To achieve this, we conduct a systematic mapping review to identify, evaluate, and interpret the relevant literature on privacy issues and PDS-based solutions in the IoT context. Our analysis is guided by three well-defined research questions, and we systematically selected 49 studies published until 2023 from an initial pool of 176 papers. We analyze and discuss the most common privacy issues highlighted by the authors and position the role of PDS technologies as a solution to privacy issues in the IoT context. As a result, our findings reveal that only a small number of works (approximately 20%) were dedicated to presenting solutions for privacy issues. Most works (almost 82%) were published between 2018 and 2023, demonstrating an increased interest in the theme in recent years. Additionally, only two works used PDS-based solutions to deal with privacy issues in the IoT context.
PubMed: 38610408
DOI: 10.3390/s24072197 -
Cureus Aug 2023Cardiovascular diseases (CVDs) present a significant global health challenge and remain a primary cause of death. Early detection and intervention are crucial for... (Review)
Review
A Systematic Review: Do the Use of Machine Learning, Deep Learning, and Artificial Intelligence Improve Patient Outcomes in Acute Myocardial Ischemia Compared to Clinician-Only Approaches?
Cardiovascular diseases (CVDs) present a significant global health challenge and remain a primary cause of death. Early detection and intervention are crucial for improved outcomes in acute coronary syndrome (ACS), particularly acute myocardial infarction (AMI) cases. Artificial intelligence (AI) can detect heart disease early by analyzing patient information and electrocardiogram (ECG) data, providing invaluable insights into this critical health issue. However, the imbalanced nature of ECG and patient data presents challenges for traditional machine learning (ML) algorithms in performing unbiasedly. Investigators have proposed various data-level and algorithm-level solutions to overcome these challenges. In this study, we used a systematic literature review (SLR) approach to give an overview of the current literature and to highlight the difficulties of utilizing ML, deep learning (DL), and AI algorithms in predicting, diagnosing, and prognosis of heart diseases. We reviewed 181 articles from reputable journals published between 2013 and June 15, 2023, focusing on eight selected papers for in-depth analysis. The analysis considered factors such as heart disease type, algorithms used, applications, and proposed solutions and compared the benefits of algorithms combined with clinicians versus clinicians alone. This systematic review revealed that the current ML-based diagnostic approaches face several open problems and issues when implementing ML, DL, and AI in real-life settings. Although these algorithms show higher sensitivities, specificities, and accuracies in detecting heart disease, we must address the ethical concerns while implementing these models into clinical practice. The transparency of how these algorithms operate remains a challenge. Nevertheless, further exploration and research in ML, DL, and AI are necessary to overcome these challenges and fully harness their potential to improve health outcomes for patients with AMI.
PubMed: 37674942
DOI: 10.7759/cureus.43003