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PloS One 2024Diabetes is a chronic disease associated with the potential for blindness, kidney failure, heart attacks, strokes, and lower limb amputations. The global prevalence of...
BACKGROUND
Diabetes is a chronic disease associated with the potential for blindness, kidney failure, heart attacks, strokes, and lower limb amputations. The global prevalence of diabetes is rising, particularly in the sub-Saharan African (SSA) region, where accessing treatment and antidiabetic drugs is complex, leading to challenges in managing the condition. Intentional and structured therapeutic education has demonstrated its ability to enhance health outcomes in diabetes patients. Given the numerous healthcare deficiencies in sub-Saharan Africa, the authors have reevaluated the role of therapeutic patient education (TPE) in this context.
METHODS
This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We queried four databases between March 14 and June 30, 2023 and conducted Cochrane's Risk of Bias analysis on the included studies. Subsequently, a qualitative synthesis of the results was performed.
RESULTS
The final analysis included thirteen studies. Seven of these, which assessed glycemic control, reported statistically significant results. Additionally, other clinical parameters such as body mass index (BMI), blood pressure, and lipid levels also exhibited some significant improvements. Knowledge substantially increased following the intervention, while attitude, self-care practices, and medication adherence showed no significant improvements. Nurse-led and peer-led intervention programs produced positive outcomes, whereas technology-based intervention methods did not yield favorable results.
CONCLUSION
TPE programs in sub-Saharan Africa have a significant impact on both clinical and non-clinical outcomes in diabetes patients. However, the sustainability of these outcomes remains uncertain. Further research is needed to assess the long-term effects of TPE on diabetes patients.
Topics: Humans; Africa South of the Sahara; Patient Education as Topic; Diabetes Mellitus; Medication Adherence; Self Care; Health Knowledge, Attitudes, Practice
PubMed: 38935594
DOI: 10.1371/journal.pone.0299526 -
Nutrients Jun 2024We conducted a systematic review and meta-analysis to examine the effect of dietary intake of cocoa on anthropometric measurements, lipid and glycemic profiles, and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
We conducted a systematic review and meta-analysis to examine the effect of dietary intake of cocoa on anthropometric measurements, lipid and glycemic profiles, and blood pressure levels in adults, with and without comorbidities.
METHODS
The databases used were MEDLINE (PubMed), EMBASE, Web of Science, Cochrane, LILACS, and SciELO. The eligible studies were randomized clinical trials (RCTs) involving adults undergoing cocoa consumption (cocoa extract or ≥70% cocoa dark chocolate) for ≥4 weeks that evaluated at least one of the following markers: body weight, body mass index (BMI), waist/abdominal circumference, total cholesterol, LDL-c, triglycerides, HDL-c, blood glucose, glycated hemoglobin (HbA1c), and systolic and diastolic blood pressure (SBP/DBP).
RESULTS
Thirty-one studies were included, totaling 1986 participants. Cocoa consumption showed no effects on body weight, BMI, waist circumference, triglycerides, HDL-c and HbA1c. Yet, there was a reduction in total cholesterol (-8.35 mg/dL, 95% CI -14.01; -2.69 mg/dL), LDL-c (-9.47 mg/dL, 95% CI -13.75; -5.20 mg/dL), fasting blood glucose (-4.91 mg/dL, 95% CI -8.29; -1.52 mg/dL), SBP (-2.52 mmHg, 95% CI -4.17; -0.88 mmHg), and DBP (-1.58 mmHg, 95% CI -2.54; -0.62 mmHg).
CONCLUSIONS
The consumption of cocoa showed protective effects on major cardiometabolic risk markers that have a clinical impact in terms of cardiovascular risk reduction.
Topics: Humans; Randomized Controlled Trials as Topic; Cacao; Cardiometabolic Risk Factors; Blood Pressure; Blood Glucose; Biomarkers; Glycated Hemoglobin; Cardiovascular Diseases; Chocolate; Male; Female; Adult; Body Mass Index; Body Weight; Waist Circumference; Middle Aged; Triglycerides; Diet; Lipids
PubMed: 38931273
DOI: 10.3390/nu16121919 -
PloS One 2024Identifying individuals at increased risk for depression allows for earlier intervention and treatment, ultimately leading to better outcomes and potentially preventing... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Identifying individuals at increased risk for depression allows for earlier intervention and treatment, ultimately leading to better outcomes and potentially preventing severe symptoms. However, to date, no systematic reviews or meta-analyses have estimated the prevalence of depression among hypertensive patients. Thus, this review was initiated to determine the prevalence and factors associated with depression among patients with hypertension in Ethiopia.
METHODS
Multiple databases, such as PubMed, African Journals Online, the Cochrane Library, and Google Scholar, were used to ensure wider coverage of relevant studies. The data extracted from Microsoft Excel were imported into STATA version 11 (Stata Corp LLC, TX, USA) for further analysis. The pooled prevalence of depression was estimated using a random effects model. To evaluate statistical heterogeneity, the Cochrane Q test and I2 statistic were used.
RESULTS
The random effect model indicated that the pooled prevalence of depression in 12 studies conducted in Ethiopia was 32.43% (95% CI: 25.18, 39.67%). Being female (POR = 2.41; 95% CI: 1.89, 3.07, I2 = 17.7%, P = 0.302), having comorbid illnesses (POR = 3.80; 95% CI: 2.09, 6.90, I2 = 81%, P = 0.005), having poor blood pressure control (POR = 3.58; 95% CI: 2.51, 5.12, I2 = 0.0%, P = 0.716), having a family history of depression (POR = 3.43; 95% CI: 1.98, 5.96, I2 = 62.6%, P = 0.069), being single (POR = 2.30; 95% CI: 1.35, 3.99, I2 = 48.0%, P = 0.146) and having poor social support (POR = 4.24; 95% CI: 1.29, 13.98, I2 = 95.8%, P<0.001) were positively associated with depression among hypertensive patients.
CONCLUSION
Overall, the results of our review showed that depression affects a significant number of Ethiopians who have hypertension. Being female, being single, having comorbidities, having poor blood pressure control, having a family history of depression, and having poor social support were factors associated with depression among patients with hypertension. For those who are depressed, improving the psycho-behavioral treatment linkage with the psychiatric unit can result in improved clinical outcomes.
TRIAL REGISTRATION
Prospero Registration number: CRD42024498447. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024498447.
Topics: Humans; Ethiopia; Hypertension; Depression; Prevalence; Risk Factors; Female; Male
PubMed: 38917087
DOI: 10.1371/journal.pone.0304043 -
Proceedings (Baylor University. Medical... 2024We conducted a comprehensive systematic review to examine the efficacy of intensive blood pressure lowering on the risk of left ventricular hypertrophy (LVH).
The effect of intensive blood pressure lowering on left ventricular hypertrophy in patients with hypertension: a systematic review and meta-analysis of randomized controlled trials.
BACKGROUND
We conducted a comprehensive systematic review to examine the efficacy of intensive blood pressure lowering on the risk of left ventricular hypertrophy (LVH).
METHODS
We searched PubMed, Scopus, Web of Science, Cochrane Central, and EMBASE for all relevant randomized controlled trials. The primary outcome was the incidence of left ventricular hypertrophy. We used the risk ratio (RR) and hazard ratio (HR) with a 95% confidence interval as our effect sizes.
RESULTS
Four studies, comprising 20,747 patients, were included. Intensive blood pressure lowering was linked with a diminished LVH incidence (RR: 0.66, 95% CI [0.56-0.77]). We also found that intensive blood pressure lowering increased the risk of LVH regression in patients with baseline LVH (RR: 1.21, 95% CI [1.11-1.32]). Finally, intensive blood pressure lowering was linked with a reduced risk of cardiovascular disease (HR: 0.71, 95% CI [0.60-0.85]). No significant heterogeneity was seen in either outcome.
CONCLUSION
Our study suggests that intensive blood pressure lowering effectively reduces the risk of LVH and cardiovascular disease. An interactive version of our analysis can be accessed here: https://databoard.shinyapps.io/lvh_hypertophy/.
PubMed: 38910799
DOI: 10.1080/08998280.2024.2346409 -
Frontiers in Pharmacology 2024[This corrects the article DOI: 10.3389/fphar.2023.1156655.].
[This corrects the article DOI: 10.3389/fphar.2023.1156655.].
PubMed: 38903988
DOI: 10.3389/fphar.2024.1426608 -
Frontiers in Cardiovascular Medicine 2024This study aimed to evaluate the effectiveness and safety of Allisartan Isoproxil in the management of hypertension.
OBJECTIVE
This study aimed to evaluate the effectiveness and safety of Allisartan Isoproxil in the management of hypertension.
METHODS
A comprehensive search was conducted across both English and Chinese databases, including the Cochrane Library, Embase, PubMed, Web of Science, Chinese Journal Full Text Database (CNKI), Wanfang Digital Periodical Full Text Database, and VIP Chinese Periodical Database (VIP), up to March 24, 2024. Randomized controlled trials (RCTs) investigating alisartan axetil for hypertension management were selected. Literature quality was assessed, and data were extracted for meta-analysis using Stata 15.1 software. The quality of evidence for outcome indicators was evaluated using the GRADE system level.
RESULTS
Six RCTs involving 767 participants were included. Meta-analysis revealed that, compared to placebo, the Allisartan Isoproxil group exhibited a significant reduction in systolic blood pressure (SBP) [WMD = -8.08, 95% CI (-11.81, 4.10), = 0.000] and brachial-ankle pulse wave velocity (baPWV) [SMD = -0.69, 95% CI (-1.17, 0.20), = 0.006]. However, the reduction in diastolic blood pressure (DBP) was not statistically significant [WMD = -5.48, 95% CI (-11.07, 0.10), = 0.054]. Additionally, compared to calcium channel blockers (CCB) and angiotensin II receptor blockers (ARB), Allisartan Isoproxil did not significantly affect SBP [WMD = 0.20, 95% CI (-3.71, 4.10), = 0.921] or DBP [WMD = 0.16, 95% CI (-2.11, 2.43), = 0.891]. Allisartan Isoproxil demonstrated superior effects in increasing nitric oxide (NO) levels and decreasing endothelin (ET) levels compared to control groups [WMD = 9.56, 95% CI (6.42, 12.71), = 0.000], [WMD = -7.42, 95% CI (-11.13, -3.71), = 0.000], and showed a higher effective control rate of blood pressure [RR = 1.26, 95% CI (1.13, 1.41), = 0.000]. Subgroup analysis did not reveal significant differences. Regarding safety, there were no statistically significant differences in adverse events between the Allisartan Isoproxil group and the control groups [RR = 0.99, 95% CI (0.74, 1.32), = 0.928], and no fatal adverse events were reported.
CONCLUSION
Allisartan Isoproxil is effective in reducing SBP and baPWV, increasing NO, decreasing ET, and achieving a higher control rate of blood pressure in patients with essential hypertension. These benefits are achieved with minimal adverse reactions.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023467869, identifier PROSPERO CRD42023467869.
PubMed: 38903964
DOI: 10.3389/fcvm.2024.1355014 -
Journal of Clinical Medicine May 2024Optimizing pain management in spinal surgery is crucial for preventing adverse events due to delayed mobilization. Magnesium sulfate has potential benefits in spinal... (Review)
Review
Optimizing pain management in spinal surgery is crucial for preventing adverse events due to delayed mobilization. Magnesium sulfate has potential benefits in spinal surgery because of its analgesic properties and modulation of neurotransmitters and autonomic nervous system. Existing evidence regarding the use of magnesium sulfate is partial and controversial, necessitating a comprehensive meta-analysis to evaluate its efficacy and safety. The aim of this study was to conduct a comprehensive meta-analysis to evaluate the efficacy and safety of magnesium sulfate in spinal surgery compared to other available options. This meta-analysis adhered to the PRISMA guidelines. Patients undergoing spinal surgery were included, with the intervention group receiving intravenous magnesium sulfate (MS) at various doses or combinations, whereas the comparison group received other alternatives or a placebo. The efficacy and safety outcomes were assessed. Data were collected from multiple databases and analyzed using Review Manager version 5.4. Heterogeneity was assessed and fixed- or random-effects models were applied. The meta-analysis included eight studies ( = 541). Magnesium sulfate demonstrated significant reductions in pain at 24 h (MD -0.20, 95% CI: -0.39 to -0.02) and opioid consumption (SMD -0.66, 95% CI: -0.95 to -0.38) compared to placebo. Additionally, a decrease in the use of muscle relaxants (SMD -0.91, 95% CI: -1.65 to -0.17) and remifentanil (SMD -1.52, 95% CI: -1.98 to -1.05) was observed. In contrast, an increase in extubation time (MD 2.42, 95% CI: 1.14 to 3.71) and verbal response (MD 1.85, 95% CI: 1.13 to 2.58) was observed compared to dexmedetomidine. In conclusion, magnesium sulfate administration in spinal surgery reduced pain and opioid consumption, and prolonged orientation and verbal response. No significant differences in blood pressure or heart rate were observed between the groups.
PubMed: 38892833
DOI: 10.3390/jcm13113122 -
PeerJ 2024Structured aerobic or resistance training alone seems to be a beneficial tool for improving glucose homeostasis, chronic systemic inflammation, resting cardiovascular... (Meta-Analysis)
Meta-Analysis
Effects of combined aerobic and resistance training on glycemic control, blood pressure, inflammation, cardiorespiratory fitness and quality of life in patients with type 2 diabetes and overweight/obesity: a systematic review and meta-analysis.
BACKGROUND
Structured aerobic or resistance training alone seems to be a beneficial tool for improving glucose homeostasis, chronic systemic inflammation, resting cardiovascular function, and mental health in people with obesity and type 2 diabetes mellitus (T2DM). The aim of the present study was to synthesize the available data on the effectiveness of combined aerobic and resistance training (CART) on glycemic control, blood pressure, inflammation, cardiorespiratory fitness (CRF), and quality of life (QoL) in overweight and obese individuals with T2DM.
METHODS
A database search was carried out in PubMed, Web of Science, Scopus, Science Direct, Cochrane Library, and Google Scholar from inception up to May 2023. The Cochrane risk of bias tool was used to assess eligible studies, and the GRADE method to evaluate the reliability of evidence. A random-effects model was used, and data were analyzed using standardized mean differences and 95% confidence intervals. The study protocol was registered in the International Prospective Register of Systematic Reviews (ID: CRD42022355612).
RESULTS
A total of 21,612 studies were retrieved; 20 studies were included, and data were extracted from 1,192 participants (mean age: 57 ± 7 years) who met the eligibility criteria. CART demonstrated significant improvements in body mass index, glycated hemoglobin, systolic and diastolic blood pressure, C-reactive protein, tumor necrosis factor-alpha, interleukin-6, CRF, and QoL compared to ST. These findings highlight the significance of exercise interventions such as CART as essential elements within comprehensive diabetes management strategies, ultimately enhancing overall health outcomes in individuals with T2DM and overweight/obesity.No differences were found in resting heart rate between CART and ST. An uncertain risk of bias and poor quality of evidence were found among the eligible studies.
CONCLUSION
These outcomes show clear evidence considering the positive role of CART in inducing beneficial changes in various cardiometabolic and mental health-related indicators in patients with T2DM and concurrent overweight/obesity. More studies with robust methodological design are warranted to examine the dose-response relationship, training parameters configuration, and mechanisms behind these positive adaptations.
Topics: Humans; Middle Aged; Blood Glucose; Blood Pressure; Cardiorespiratory Fitness; Diabetes Mellitus, Type 2; Exercise; Glycemic Control; Inflammation; Obesity; Overweight; Quality of Life; Resistance Training
PubMed: 38887616
DOI: 10.7717/peerj.17525 -
Frontiers in Physiology 2024Endothelial dysfunction indicates blood vessel injury and is a risk factor for cardiovascular diseases. Blueberry has been approved for its benefits on human health,...
Endothelial dysfunction indicates blood vessel injury and is a risk factor for cardiovascular diseases. Blueberry has been approved for its benefits on human health, especially on cardiovascular function. However, its effect on endothelial function remains unclear. We conducted a systematic review and meta-analysis to explore the impact of blueberries on endothelial function in adults. We searched PubMed, Web of Science, Embase, and the Cochrane Library, 16 studies were included in the systematic review, and 11 were used for the meta-analysis. Data associated with endothelial function were extracted and pooled as mean differences (MD) with 95% confidence intervals (CI). Blueberry consumption significantly improved flow-mediated dilation (FMD) by 1.50% (95% CI: 0.81, 2.20; I = 87%) and reactive hyperemia index (RHI) by 0.26 (95% CI: 0.09, 0.42; I = 72%). A significant decrease in diastolic blood pressure (DBP) was also observed (MD: -2.20 mm Hg; 95% CI: -4.13, -0.27; I = 11%). Subgroup analysis indicated a significant decrease in blood pressure (Systolic blood pressure [SBP]: -3.92 mmHg; 95% CI: -6.88, -0.97; I = 20% and DBP: -2.20 mmHg; 95% CI: -4.13, -0.27; I = 11%) in the smoking population. However, SBP levels (MD: -1.43 mm Hg; 95% CI: -3.11, 0.26; I = 20%) and lipid status (high-density lipoprotein cholesterol [HDL-C]: 0.06; 95% CI: -0.04, 0.16; I = 77%; low-density lipoprotein cholesterol [LDL-C]: 0.05; 95% CI: -0.14, 0.24; I = 0%) did not significantly improve. Blueberry intervention improved endothelial function and DBP. Subgroup analysis revealed a notable improvement in blood pressure among the smoking population. However, no significant effects were observed on SBP, HDL-C, and LDL-C levels. Future research should delve into the mechanisms of endothelial improvement and verify blood pressure reduction in specific subpopulations through large-scale trials. https://www.crd.york.ac.uk/PROSPERO/, Identifier CRD42023491277.
PubMed: 38887319
DOI: 10.3389/fphys.2024.1368892 -
Frontiers in Endocrinology 2024This study aimed to distinguish between healthy controls and patients with OSAHS regarding homocysteine (HCY) levels and investigate how individuals with OSAHS respond... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This study aimed to distinguish between healthy controls and patients with OSAHS regarding homocysteine (HCY) levels and investigate how individuals with OSAHS respond to continuous positive airway pressure ventilation (CPAP) in terms of serum and plasma HCY levels.
METHODS
To ascertain published articles about OSAHS, an exhaustive search was performed across medical databases, encompassing PubMed, Web of Science, EMBASE, CNKI, and Cochrane Library, until January 2, 2024. This study reviewed the literature regarding HCY levels in individuals with OSAHS and control groups, HCY levels under pre- and post-CPAP treatment, the Pearson/Spearman correlation coefficients between HCY levels and apnea-hypopnea index (AHI), and the hazard ratio (HR) of HCY levels concerning the occurrence of major adverse cerebrocardiovascular events (MACCEs) in patients with OSAHS. Meta-analyses were performed using weighted mean difference (WMD), correlation coefficients, and HR as effect variables. The statistical analysis was conducted using the R 4.1.2 and STATA 11.0 software packages.
RESULTS
In total, 33 articles were selected for the final analysis. The OSAHS group exhibited significantly higher serum/plasma HCY levels than the control group (WMD = 4.25 μmol/L, 95% CI: 2.60-5.91, < 0.001), particularly among individuals with moderate and severe OSAHS. Additionally, subgroup analysis using mean age, ethnicity, mean body mass index, and study design type unveiled significantly elevated levels of HCY in the serum/plasma of the OSAHS group compared to the control group. CPAP treatment can significantly decrease serum/plasma HCY levels in patients with OSAHS. Moreover, elevated HCY levels in individuals with OSAHS could be one of the risk factors for MACCEs (adjusted HR = 1.68, 95% CI = 1.10-2.58, = 0.017). AHI scores show a positive correlation with serum/plasma HCY levels.
CONCLUSION
Patients with OSAHS had elevated serum/plasma HCY levels compared to healthy controls; however, CPAP therapy dramatically decreased HCY levels in patients with OSAHS. In patients with OSAHS, elevated HCY levels were linked with an increased risk of MACCEs, and HCY was positively connected with AHI values. HCY levels may serve as a useful clinical indicator for determining the severity and efficacy of OSAHS treatments.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier CRD42024498806.
Topics: Humans; Sleep Apnea, Obstructive; Homocysteine; Continuous Positive Airway Pressure
PubMed: 38887264
DOI: 10.3389/fendo.2024.1378293