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Medicine Nov 2015Type 2 diabetes mellitus (T2DM) is a group of metabolic diseases of multiple etiologies. Although great progress has been made, researchers are still working on the... (Meta-Analysis)
Meta-Analysis Review
Type 2 diabetes mellitus (T2DM) is a group of metabolic diseases of multiple etiologies. Although great progress has been made, researchers are still working on the pathogenesis of T2DM and how to best use the treatments available. Aside from several novel pharmacological approaches, catheter-based sympathetic renal denervation (RDN) has gained a significant role in resistant hypertension, as well as improvements in glycemic control in T2DM.In this article, we will summarize herein the role sympathetic activation plays in the progression of T2DM and review the recent clinical RDN experience in glucose metabolism.We performed systematic review in online databases, including PubMed, EmBase, and Web of Science, from inception until 2015.Studies were included if a statistical relationship was investigated between RDN and T2DM.The quality of each included study was assessed by Newcastle-Ottawa scale score. To synthesize these studies, a random-effects model or a fixed-effects model was applied as appropriate. Then, we calculated heterogeneity, performed sensitivity analysis, tested publication bias, and did meta-regression analysis. Finally, we identified 4 eligible articles.In most studies, RDN achieved via novel catheter-based approach using radiofrequency energy has gained a significant role in resistant hypertension, as well as improvements in glycemic control in T2DM. But the DREAMS-Study showed that RDN did not change median insulin sensitivity nor systemic sympathetic activity.Firstly, the current published studies lacked a proper control group, along with the sample capacity was small. Also, data obtained in the subgroups of diabetic patients were not separately analyzed and the follow-up period was very short. In addition, a reduction in blood pressure accounts for the improvements in glucose metabolism and insulin resistance cannot be excluded.If the favorable result of better glucose metabolism is confirmed in large-scale, randomized studies, RDN may emerge as a novel therapeutic option for patients with T2DM.
Topics: Diabetes Mellitus, Type 2; Humans; Kidney; Sympathectomy
PubMed: 26554798
DOI: 10.1097/MD.0000000000001932 -
Surgery Sep 2022Enhanced recovery after surgery programs have improved patient outcomes following colorectal surgery. This has provided a platform for the consideration of ambulatory... (Review)
Review
BACKGROUND
Enhanced recovery after surgery programs have improved patient outcomes following colorectal surgery. This has provided a platform for the consideration of ambulatory colectomies where patients are discharged within 24 hours after surgery. Although some studies have demonstrated its feasibility, the safety profile and patient eligibility criteria for discharge within 24 hours after surgery remain relatively ill-defined. This study provided a review of the patient selection criteria and postoperative outcomes shown in patients discharged within 24 hours after surgery.
METHODS
Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines were adhered to. A comprehensive search was performed on 3 electronic databases, and the relevant articles were identified. The primary outcome measures were postoperative morbidity and readmission rates. The different domains relevant to the selection of patients and perioperative care of patients discharged within 24 hours after surgery were also qualitatively assessed.
RESULTS
Eight studies were included, which involved a total of 1,229 patients. The majority of selected patients underwent elective laparoscopic colonic surgeries. The patient characteristics, such as age, comorbidities, obesity, and psychosocial environment, were important considerations. A close follow-up with home-based medical services was ideal in patients discharged within 24 hours after surgery. The readmission rates ranged from 0.0% to 9.0%. Despite morbidity rates of up to 26.7%, the majority of them were minor and classified as Clavien-Dindo Grade I to II.
CONCLUSION
The use of programs related to discharge within 24 hours after surgery in colorectal surgery is safe, feasible, and practical in a select group of patients within a well-designed clinical framework and pathway. Future studies should compare patient outcomes following discharge within 24 hours after surgery with conventional enhanced recovery after surgery protocols. In addition, patient and caregiver perceptions, quality of life, and cost-effectiveness analysis should also be performed.
Topics: Colectomy; Colon; Humans; Laparoscopy; Patient Discharge; Quality of Life
PubMed: 35840425
DOI: 10.1016/j.surg.2022.04.050 -
L'Encephale Sep 2015Pathological nighttime fears in children have been little studied. However, this disorder is commonly encountered in medical consultations and is discomforting and... (Review)
Review
OBJECTIVE
Pathological nighttime fears in children have been little studied. However, this disorder is commonly encountered in medical consultations and is discomforting and dysfunctional for both the child and the family. Most nighttime fears are part and parcel of normal development, and emanate from increasingly sophisticated cognitive development in the growing child. Thus, most children report a variety of coping strategies generally helpful in reducing their anxiety, which resolves spontaneously in the growing child. Nevertheless, in about 10% of children, nighttime fears are related to one or more anxiety disorders according to Diagnostic and Statistical Manual of Mental Disorders criteria. Then, it is estimated that severe nighttime fears and sleep problems occur in 20-30% of children. This problem is not transient and has to be treated. This study aims to review clinical features of nighttime fears and possible treatments for these patients and their families.
METHOD
This systematic review follows the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement guidelines. Two databases (Medline and Web of Science) were searched combining the search terms: nighttime fears AND children. English and French languages were imposed. There were no publication date or publication status limitations.
RESULTS
Pathological nighttime fears are responsible for emotional (crying, panic, tantrums at bedtime, loss of confidence, self-disparaging negative statements, and feeling of social embarrassment) and behavioral (wandering alone in the house at night, calls for parental or sibling comfort, bed sharing with parents or siblings, light source at night, refusal to go to the toilet alone at night) disturbances. This leads to a poor quality of sleep interfering with school learning, and also affects social development and family functioning. A full assessment has to be made to eliminate organic causes, have a baseline functioning, and search for comorbid anxiety diseases. The treatments which have proved effective are some cognitive-behavioral techniques: systematic desensitization (with relaxation or emotive imagery), reinforcement (gain of points and techniques of self statement), and cognitive techniques (reinforcing self-statements, reducing the aversive aspects of being in the dark, involving reality-testing statements, and active control are preferred in children older than 6 years, whereas the "anti-monster letter" and the techniques using a doll are preferred in children under 6 years old). The modelling technique seems to be appropriate at any age.
CONCLUSION
We have explained the clinical features of pathological nighttime fears and the way to assess this disease, and we have pointed out the treatments whose effectiveness has been evaluated in this indication.
Topics: Adaptation, Psychological; Anxiety; Child; Child Development; Child, Preschool; Darkness; Dreams; Emotions; Fear; Humans; Sleep
PubMed: 25542451
DOI: 10.1016/j.encep.2014.10.022 -
Journal of Visualized Experiments : JoVE Feb 2023A systematic review and meta-analysis were conducted to evaluate the clinical effectiveness and safety of Shugan Jieyu capsules for treating insomnia by searching seven... (Meta-Analysis)
Meta-Analysis
A systematic review and meta-analysis were conducted to evaluate the clinical effectiveness and safety of Shugan Jieyu capsules for treating insomnia by searching seven databases up to February 21, 2022. The study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The quality of the studies was assessed using the risk of bias assessment tool. This article describes in detail how to retrieve and screen the literature. The detailed steps for conducting the meta-analysis are also included in the protocol. Fourteen studies were found to be eligible, including 1,283 insomnia patients (644 with and 639 without Shugan Jieyu capsules at baseline). The meta-analysis showed a better total clinical effectiveness (odds ratio [OR]: 5.71, 95% confidence interval [CI]: 3.56 to 9.15) and a lower Pittsburgh Sleep Quality Index (PSQI) score (mean difference [MD]: -2.95, 95% CI: -4.97 to -0.93) with combined Shugan Jieyu capsules and Western medicine compared to Western medicine alone. The secondary outcomes showed that the Shugan Jieyu capsule group had significantly reduced adverse reactions and improvements in sleep duration, night awakening, nightmares with excessive dreaming, daytime sleepiness, and low energy. Further multicenter randomized trials must be encouraged to provide more concrete evidence on whether Shugan Jieyu capsules are beneficial in routine clinical practice.
Topics: Humans; Capsules; Databases, Factual; Sleep Duration; Sleep Initiation and Maintenance Disorders; Drugs, Chinese Herbal
PubMed: 36876948
DOI: 10.3791/64660 -
Journal of Clinical Sleep Medicine :... Oct 2008The aim of this review is to evaluate the effectiveness of cognitive behavioral therapy (CBT) on nightmare frequency and to determine which kind of CBT is the most... (Comparative Study)
Comparative Study Review
The aim of this review is to evaluate the effectiveness of cognitive behavioral therapy (CBT) on nightmare frequency and to determine which kind of CBT is the most effective treatment. A systematic literature search was carried out in PsychInfo and PubMed articles published on or before May 1, 2008. The inclusion criteria were: nightmare treatment study, use of nonpharmacological treatment, not a qualitative case study, randomized-controlled trial (RCT). After selection, 12 peer-reviewed studies about 9 RCTs remained (2 follow-up studies and one displaying preliminary results). Several interventions have been reviewed including, recording one's nightmares, relaxation, exposure, and techniques of cognitive restructuring. The 12 evaluated articles varied in quality, and none fulfilled CONSORT guidelines. All articles used nightmare frequency as the primary dependent variable, and all found significant in-group differences (pre vs. post) for intervention or placebo (range d = 0.7-2.9). Five studies were able to find a significant group effect for the intervention compared to a waiting list control group. Only one study found significant differences between 2 intervention groups. Nightmare-focused CBT (exposure and imagery rehearsal therapy [IRT]) revealed better treatment outcomes than indirect CBT (relaxation, recording). IRT and exposure showed no meaningful differences, but only one RCT directly compared both techniques. Three different research groups demonstrated the effects of exposure, but only one group showed the effect of IRT. Thus, RCTs that compare IRT with exposure by independent research groups are much needed.
Topics: Cognitive Behavioral Therapy; Desensitization, Psychologic; Dreams; Humans; Imagination; Practice, Psychological; Randomized Controlled Trials as Topic; Relaxation Therapy
PubMed: 18853707
DOI: No ID Found -
The Cochrane Database of Systematic... Jul 2006Problems with memory which do not meet the diagnostic criteria for dementia, usually called mild cognitive impairment (MCI), can be the first sign of an impending... (Review)
Review
BACKGROUND
Problems with memory which do not meet the diagnostic criteria for dementia, usually called mild cognitive impairment (MCI), can be the first sign of an impending dementia, particularly Alzheimer's disease (AD). There is no consensus on a definition or diagnostic criteria for MCI, and MCI remains a vague term and those so described are a heterogeneous population, consisting of people who may rapidly progress to dementia but also of people with stable cognitive deficits and some who may actually improve. Treatment in the very earliest stages of AD may delay progression to AD. Donepezil (Aricept, E2020), a cholinesterase inhibitor, has been shown to benefit all severities of AD including mild and it would be reasonable to investigate its efficacy for those with MCI.
OBJECTIVES
To assess the effects of donepezil in people with mild cognitive impairment but no diagnosis of dementia.
SEARCH STRATEGY
The trials were identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 6 January 2006. This register contains records from major health care databases like CENTRAL, MEDLINE, EMBASE, CINAHL and PsycINFO and many ongoing trial databases and is updated regularly.
SELECTION CRITERIA
All double blind, randomized trials in which treatment with donepezil was compared with placebo for patients with mild cognitive impairment.
DATA COLLECTION AND ANALYSIS
Data were extracted from the published reports of the included studies, pooled where appropriate and the treatment effects or the risks and benefits estimated.
MAIN RESULTS
The two included studies, with a total of 782 patients, all with a MMSE greater than 23 points, identified similar patients for inclusion, but were quite different with respect to design and objective. Pooling results in a meta-analysis was not possible. In the first study the 13-item ADAS-Cog showed benefit associated with 10 mg/day donepezil compared with placebo at 24 weeks (MD 1.90, 95% CI 0.51 to 3.29, p=0.007), but four other measures of cognitive function did not. The analysis of withdrawals before the end of treatment at 24 weeks, withdrawals due to an adverse event, and numbers experiencing an adverse event, showed a significant difference between the donepezil group and the placebo group in favour of placebo, (43/133 donepezil 23/137 placebo, OR 2.37, 95% CI 1.33 to 4.22, p=0.003), (29/133 donepezil 10/137 placebo, OR 3.54, 95% CI 1.65 to 7.60, p=0.001), (116/133 donepezil, 100/137 placebo, OR 2.52 95% CI 1.34 to 4.76, p=0.004). Various adverse effects were recorded, and several types of event, diarrhoea, nausea, vomiting, leg cramps and abnormal dreams, were reported more frequently in the donepezil group compared with the placebo. In the second study there was a significant difference between the number of patients diagnosed with AD or another dementia between the donepezil group and the placebo group in favour of donepezil after one year of treatment (16/253 donepezil 38/259 placebo) (OR 0.39, 95% CI 0.21 to 0.72, p=0.003), but no difference after 3 years of treatment (63/253 donepezil 73/259 placebo) (OR 0.84, 95% CI 0.57 to 1.25, p=0.4).
AUTHORS' CONCLUSIONS
There are two included studies. One study demonstrated a modest treatment effect in cognitive function as assessed by ADAS-Cog13 but not for other outcomes assessing different domains of cognitive function. Donepezil was associated with significantly more adverse effects compared with placebo, mostly gastrointestinal. From the second study, there is no evidence that donepezil delays the onset of AD. There is no evidence to support the use of donepezil for patients with MCI. The putative benefits are minor, short lived and associated with significant side effects.
Topics: Donepezil; Humans; Indans; Memory Disorders; Nootropic Agents; Piperidines; Randomized Controlled Trials as Topic
PubMed: 16856114
DOI: 10.1002/14651858.CD006104 -
Journal of Sleep Research Jun 2023A 'new' way of dreaming has emerged during the pandemic, enhancing the interest of psychological literature. Indeed, during the years of the spread of coronavirus...
A 'new' way of dreaming has emerged during the pandemic, enhancing the interest of psychological literature. Indeed, during the years of the spread of coronavirus disease 2019 (COVID-19), many studies have investigated dream-related phenomena and dreaming functions. Considering the constant and rapid emergence of new results on this topic, the main aim of this study was to create an 'observatory' on the short- and long-term consequences of the COVID-19 pandemic on dreaming, by means of a living systematic review. The baseline results are presented, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines, to identify and discuss existing studies about dreams and dreaming during the COVID-19 pandemic published until February 2022. Web of Science, Embase, EBSCO, and PubMed were used for the search strategy, yielding 71 eligible papers included in the review. Our results show: (a) a more intense oneiric activity during lockdown; (b) changes in dreaming components (especially dream-recall and nightmare frequency); (c) a particular dreaming scenario ('pandemic dreams'); (d) an alteration of the dreaming-waking-life continuum and a specific function of dreaming as emotional regulator. Findings suggest that monitoring changes in dreaming provides important information about psychological health and could also contribute to the debate on the difficulties of dreaming, as well as sleeping, in particular during and after a period of 'collective trauma'.
Topics: Humans; Communicable Disease Control; COVID-19; Dreams; Pandemics; Sleep
PubMed: 36320190
DOI: 10.1111/jsr.13742 -
Sleep Medicine Mar 2020Nightmares are a highly prevalent and distressing feature of post-traumatic stress disorder (PTSD). Previous studies have reached mixed conclusions regarding the effects... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Nightmares are a highly prevalent and distressing feature of post-traumatic stress disorder (PTSD). Previous studies have reached mixed conclusions regarding the effects of prazosin on nightmares, sleep quality, and overall PTSD symptoms in patients with PTSD.
METHODS
MEDLINE, EMBASE, all EBM databases, PsycIFNO, and CINAHL were systematically searched from inception date to October 2018 for randomized clinical trials that included reporting of nightmares, sleep quality or overall PTSD symptoms. The analysis included data from eight trials involving 286 PTSD patients in the prazosin group and 289 PTSD patients in the placebo group.
RESULTS
In our meta-analysis, prazosin resulted in a statistically significant improvement in nightmares (standardized mean difference (SMD) = -1.13, 95% confidence interval (CI) = -1.91 to -0.36), but was not more beneficial than placebo for overall PTSD symptoms (SMD = -0.45, 95% CI = -0.95 to 0.05) and sleep quality (SMD = -0.44, 95% CI = -1.44 to 0.55). In terms of acceptability, there was no significant difference between the prazosin group and the placebo group with respect to discontinuation for all causes (odds ratio (OR) = 1.00, 95% CI = 0.62-1.62). In conclusion, the use of prazosin was associated with an improvement of nightmare symptoms.
CONCLUSION
Our findings indicate that additional studies are needed before considering downgrading the use of prazosin in the treatment of nightmares in patients with PTSD.
Topics: Antihypertensive Agents; Dreams; Humans; Prazosin; Randomized Controlled Trials as Topic; Sleep Wake Disorders; Stress Disorders, Post-Traumatic
PubMed: 31972510
DOI: 10.1016/j.sleep.2019.06.010 -
BMC Complementary Medicine and Therapies Jun 2020African Potato (hypoxis hemerocallidea), is used for enhancing immune system in Southern Africa. It is among the plants of intense commercial and scientific interest;...
BACKGROUND
African Potato (hypoxis hemerocallidea), is used for enhancing immune system in Southern Africa. It is among the plants of intense commercial and scientific interest; hence, the aim of this study was to describe its chemistry and pharmacology.
METHODS
PubMed, Cochrane Controlled Trials Register (CENTRAL) and Google Scholar were searched independently for relevant literature. The last search occurred in October 2018. Other research material was obtained from Google. The following search terms were used, but not limited to: "African Potato", "hypoxis", "hemerocallidea", "rooperol." Articles that were explaining the chemistry and pharmacology of hypoxis hemerocallidea were included.
RESULTS
Thirty articles from PubMed, Cochrane and Google Scholar were eligible. Three webpages were included from Google. Results showed that the tuberous rootstock (corm) of African Potato is used traditionally to treat wasting diseases, testicular tumours, insanity, barrenness, impotency, bad dreams, intestinal parasites, urinary infection, cardiac disease and enhancing immunity. The plant contains hypoxoside, which is converted rapidly to a potent antioxidant, rooperol in the gut. The corm contains sterols, sterol glycosides, stanols, terpenoids, saponins, cardiac glycosides, tannins and reducing sugars. A dose of 15 mg/kg/day of hypoxoside is reportedly therapeutic. Preclinical studies of African Potato have shown immunomodulation, antioxidant, antinociceptive, hypoglycaemic, anti-inflammatory, anticonvulsant, antibacterial, uterolytic, antimotility, spasmolytic and anticholinergic effects. The common side effects of African Potato are nausea and vomiting, which subside over time. In vitro, African Potato demonstrated inhibitory effects on CYP1A2, 2C9, 2D6, 3A4, 3A5, CYP19-metabolism and induction of P-glycoprotein. In vivo, it did not alter the pharmacokinetics of efavirenz or lopinavir/ritonavir.
CONCLUSION
African Potato is mainly used as an immunostimulant. The exact mechanisms of action for all the pharmacological actions are unknown. More research is required to substantiate claims regarding beneficial effects. There are many research gaps that require investigation including pharmacokinetic interactions with conventional drugs, especially those used in HIV/AIDS.
Topics: Africa; Catechols; Humans; Hypoxis; Medicine, African Traditional; Plant Extracts; Plants, Medicinal
PubMed: 32527245
DOI: 10.1186/s12906-020-02956-x -
Journal of Thoracic Oncology : Official... Jan 2024Dual immune checkpoint blockers regimen represents a standard first-line therapy in unresectable pleural mesothelioma (PM). Novel combination strategies, including... (Meta-Analysis)
Meta-Analysis
Meta-Analysis on the Combination of Chemotherapy With Programmed Death-Ligand 1 and Programmed Cell Death Protein 1 Blockade as First-Line Treatment for Unresectable Pleural Mesothelioma.
INTRODUCTION
Dual immune checkpoint blockers regimen represents a standard first-line therapy in unresectable pleural mesothelioma (PM). Novel combination strategies, including immune checkpoint blockers and antiangiogenic drugs, are currently under investigation in this setting. We aimed to assess the efficacy of the chemoimmunotherapy combination by reference to literature evidence.
METHODS
A systematic review and meta-analysis of trials with first-line platinum-based chemotherapy associated with programmed death-ligand 1 and programmed cell death protein 1 agent in unresectable PM. We estimated the weighted summary proportion of disease response, along with the landmark probability of survival outcomes.
RESULTS
A total of 349 patients with unresectable PM from four trials (DREAM, PrE0505, JME-001, and IND.227) were included, 79% (n = 274) with epithelioid and 21% (n = 75) with nonepithelioid histologic type. In aggregate, the objective response rate was 59.2% (95% confidence interval [CI]: 50.3%-67.9%) and disease control rate was 92.2% (95% CI: 89.2%-94.8%). Comparing epithelioid versus nonepithelioid tumors, the objective response rate was 64.5% versus 46.4%, (p < 0.001) and the disease control rate was 92.3% versus 80.0%, (p = 0.043), with an OR of 2.56 (95% CI: 1.51-4.32) for disease response and of 3.37 (95% CI: 0.99-11.47) for disease control. The aggregated estimated probability of progression-free survival was 63% (95% CI: 53%-71%) at 6 months and 25% (95% CI: 21%-31%) at 12 months, whereas the 6-, 12- and 24-month overall survival rates were 88% (95% CI: 81%-93%), 71% (95% CI: 61%-79%) and 39% (95% CI: 34%-45%), respectively.
CONCLUSIONS
According to our analysis, first-line chemoimmunotherapy holds promise as a new treatment approach for PM, exhibiting encouraging survival outcomes and an enhanced response rate, including for the epithelioid subtype. Ongoing studies are necessary to establish its precise placement within the treatment algorithm.
Topics: Humans; Antineoplastic Combined Chemotherapy Protocols; Immune Checkpoint Inhibitors; Ligands; Lung Neoplasms; Mesothelioma; Mesothelioma, Malignant; Pleural Neoplasms; Programmed Cell Death 1 Receptor
PubMed: 37567387
DOI: 10.1016/j.jtho.2023.08.004