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Cancer Causes & Control : CCC Oct 2021Evidence of differences in the etiology of, and poorer survival from, proximal colon compared to the distal colorectum, necessitates research into its risk factors. This... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Evidence of differences in the etiology of, and poorer survival from, proximal colon compared to the distal colorectum, necessitates research into its risk factors. This systematic review summarizes the evidence on medication use and proximal colon cancer risk.
METHODS
MEDLINE and EMBASE were searched for prospective studies investigating nine medication groups, namely non-steroidal anti-inflammatory drugs (NSAIDs), exogenous hormones, i.e., hormone replacement therapy (HRT) or oral contraceptives (OCs), statins, proton pump inhibitors, anti-hypertensives, metformin (an antidiabetic), antidiarrheals or laxatives, and the risk of proximal colon cancer. Narrative synthesis and meta-analyses, using random effects models to estimate risk ratios (RRs) and 95% confidence intervals (CIs), were conducted.
RESULTS
Twenty nine publications investigating NSAIDs (n = 13), exogenous hormones [HRT (n = 9) or OCs (n = 4)] statins (n = 5), anti-hypertensives (n = 1), and metformin (n = 1) were included. Summary RRs reported a protective effect of aspirin use (RR 0.80, 95% CI 0.73-0.89) but no associations between HRT (RR 0.92, 95% CI 0.83-1.02), OC (RR 1.06, 95% CI 0.98-1.14) or statin use (RR 0.94, 95% CI 0.67-1.31), and proximal colon cancer incidence compared to never/non-use. One study on metformin and one on anti-hypertensives reported no association. Sources of between-study heterogeneity included study design, period of exposure ascertainment, exposure source, and exposure comparison, but this exploration was hindered by the small numbers of studies.
CONCLUSION
Despite some studies on NSAID or HRT use, evidence on the impact of a range of medications on proximal colon cancer risk is limited. This highlights the need for more research to inform chemoprevention strategies.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Colonic Neoplasms; Humans; Prospective Studies; Risk Factors
PubMed: 34224060
DOI: 10.1007/s10552-021-01472-8 -
Journal of Substance Abuse Treatment Oct 2021Some countries have used opioid agonist medications other than methadone and buprenorphine as a strategy to increase treatment diversity. In Iran and other countries... (Review)
Review
BACKGROUND
Some countries have used opioid agonist medications other than methadone and buprenorphine as a strategy to increase treatment diversity. In Iran and other countries where opium use is common and culturally tolerated, opium tincture (OT) has gained growing popularity and been approved to treat opioid use disorder (OUD). Given the increasing interest in this intervention, we conducted a systematic review of the literature to evaluate the safety and efficacy of OT-assisted treatment for OUD.
METHODS
We systematically searched international (MEDLINE, Embase, CINAHL, PsychInfo, Google Scholar, and clinicaltrials.gov) and Iranian (Scientific Information Database (SID), Iranmedex, IranDoc, digital library of Iran's Drug Control Headquarters and the Iranian Registry for Clinical Trials) databases on November 04, 2020 without any language or publication date limitations. Two reviewers screened the titles, abstracts, and full-text of the retrieved records to find clinical trials or observational studies that assessed the safety and efficacy of OT-assisted treatment for OUD.
RESULTS
We screened 1301 records and included 21 unique studies on assisted withdrawal (n = 5), maintenance (n = 9), and gradual dose reduction (n = 7) treatment regimens. Most studies included men and people with opium use disorder. We found only six randomized controlled trials (RCT). Our results showed that OT-assisted treatment is associated with comparable outcomes with methadone treatment in both assisted withdrawal and maintenance treatment regimens. We also found promising results for using gradual dose reduction regimen of OT-assisted treatment from observational studies. The overall quality of scientific evidence was low due to the limited number RCT and high risk of bias in the included studies.
CONCLUSIONS
The body of evidence supporting the safety and efficacy of OT-assisted treatment in assisted withdrawal, maintenance, and gradual dose reduction regimens is limited but somewhat promising, in particular among people with opium use disorder. Our review calls for higher-quality studies to investigate the comparative efficacy of these treatment methods with standard pharmacotherapies for OUD.
Topics: Buprenorphine; Humans; Male; Methadone; Opiate Substitution Treatment; Opioid-Related Disorders; Opium
PubMed: 34119894
DOI: 10.1016/j.jsat.2021.108519 -
Pediatrics Jun 2021Functional abdominal pain disorders (FAPDs) are common in childhood, impacting quality of life and school attendance. There are several compounds available for the...
CONTEXT
Functional abdominal pain disorders (FAPDs) are common in childhood, impacting quality of life and school attendance. There are several compounds available for the treatment of pediatric FAPDs, but their efficacy and safety are unclear because of a lack of head-to-head randomized controlled trials (RCTs).
OBJECTIVE
To systematically review the efficacy and safety of the pharmacologic treatments available for pediatric FAPDs.
DATA SOURCES
Electronic databases were searched from inception to February 2021.
STUDY SELECTION
RCTs or systematic reviews were included if the researchers investigated a study population of children (4-18 years) in whom FAPDs were treated with pharmacologic interventions and compared with placebo, no treatment, or any other agent.
DATA EXTRACTION
Two reviewers independently performed data extraction and assessed their quality. Any interresearcher disagreements in the assessments were resolved by a third investigator.
RESULTS
Seventeen articles representing 1197 children with an FAPD were included. Trials investigating antispasmodics, antidepressants, antibiotics, antihistaminic, antiemetic, histamine-2-receptor antagonist, 5-HT4-receptor agonist, melatonin, and buspirone were included. No studies were found on treatment with laxatives, antidiarrheals, analgesics, antimigraines, and serotonergics.
LIMITATIONS
The overall quality of evidence on the basis of the Grading of Recommendations, Assessment, Development and Evaluations system was very low to low.
CONCLUSIONS
On the basis of current evidence, it is not possible to recommend any specific pharmacologic agent for the treatment of pediatric FAPDs. However, agents such as antispasmodics or antidepressants can be discussed in daily practice because of their favorable treatment outcomes and the lack of important side effects. High-quality RCTs are necessary to provide adequate pharmacologic treatment. For future intervention trials, we recommend using homogenous outcome measures and instruments, a large sample size, and long-term follow-up.
Topics: Abdominal Pain; Child; Drug-Related Side Effects and Adverse Reactions; Humans; Treatment Outcome
PubMed: 34045320
DOI: 10.1542/peds.2020-042101 -
Clinical and Translational Radiation... Jul 2021Pelvic radiotherapy (RT) often results in gastrointestinal toxicity and clinical trials have demonstrated a potential benefit of dietary supplements in alleviating acute...
The role of dietary supplements, including biotics, glutamine, polyunsaturated fatty acids and polyphenols, in reducing gastrointestinal side effects in patients undergoing pelvic radiotherapy: A systematic review and meta-analysis.
BACKGROUND AND PURPOSE
Pelvic radiotherapy (RT) often results in gastrointestinal toxicity and clinical trials have demonstrated a potential benefit of dietary supplements in alleviating acute effects. However, no prophylactic agents have been approved to date for relief of gastrointestinal side-effects caused by pelvic radiation. In this systematic review, we evaluated the efficacy of dietary supplements in preventing or alleviating symptoms of gastrointestinal toxicity in patients undergoing pelvic RT.
MATERIALS AND METHODS
CENTRAL, MEDLINE, EMBASE, and ClinicalTrials.gov were searched up to June 2020 for randomised controlled trials. Interventions included four supplement categories: biotics, glutamine, poly-unsaturated fatty acids and polyphenols. Efficacy was determined with reference to outcomes based on symptoms of acute gastrointestinal toxicity, including diarrhoea, nausea, vomiting, flatulence/bloating, bowel movement frequency, tenesmus and rectal bleeding.
RESULTS
Twenty-three randomised controlled trials (1919 patients) were identified in this review. Compared with placebo, probiotics (RR = 0.71; 95% CI: 0.52 to 0.99), synbiotics (RR = 0.45; 95% CI: 0.28 to 0.73) and polyphenols (RR = 0.30; 95% CI: 0.13 to 0.70) were significantly associated with a lower risk of diarrhoea. Biotic supplements also reduced the risk of moderate to severe diarrhoea (RR = 0.49; 95% CI: 0.36 to 0.67) and the need for anti-diarrhoeal medication (RR = 0.64; 95%CI: 0.44 to 0.92). In contrast, glutamine had no effect on acute symptoms (RR = 1.05; 95% CI: 0.86 to 1.29). There was a non-significant trend for reduction in nausea and mean bowel movements per day using dietary supplements.
CONCLUSIONS
Biotic supplements, especially probiotics and synbiotics, reduce acute symptoms of gastrointestinal toxicity in patients undergoing pelvic radiotherapy.
PubMed: 34027139
DOI: 10.1016/j.ctro.2021.04.006 -
Evidence-based Complementary and... 2021Many studies have been undertaken on the medicinal values of Lam. ex DC. (Fabaceae). The details, however, are highly fragmented in different journals, libraries, and... (Review)
Review
BACKGROUND
Many studies have been undertaken on the medicinal values of Lam. ex DC. (Fabaceae). The details, however, are highly fragmented in different journals, libraries, and other publication media. This study was therefore conducted to provide a comprehensive report on its ethnobotany, ethnomedicinal uses, phytochemicals, and the available pharmacological evidence supporting its efficacy and safety in traditional medicine.
METHOD
We collected data using a PROSPERO registered systematic review protocol on the ethnobotany, phytochemistry, and ethnopharmacology of from 132 reports that were retrieved from electronic databases. Documented local names, morphology, growth habit and habitat, ethnomedicinal and nonmedicinal uses, diseases treated, parts used, method of preparation and administration, extraction and chemical identity of isolated compounds, and efficacy and toxicity of extracts and isolated compounds were captured. Numerical data were summarized into means, percentages, and frequencies and presented as graphs and tables.
RESULTS
is harvested by traditional herbal medicine practitioners in East, Central, and South African communities to prepare herbal remedies for various human and livestock ailments. These include bacterial and fungal infections, tuberculosis, malaria, HIV/AIDS, diarrhea, cancer, meningitis, inflammatory diseases, urinary tract infections, wounds, diabetes mellitus, and skin and soft tissue injuries. Different extracts and phytochemicals from parts of have been scientifically proven to possess anti-inflammatory, antibacterial, antioxidant, antiplasmodial, antiproliferative, antifungal, antimycobacterial, antidiarrheal, anti-HIV 1, antidiabetic, and antiobesity activities. This versatile pharmacological activity is due to the abundant flavonoids, alkaloids, and terpenoids present in its different parts.
CONCLUSION
is an important ethnomedicinal plant in Africa harboring useful pharmacologically active phytochemicals against various diseases with significant efficacies and minimal toxicity to mammalian cells. Therefore, this plant should be conserved and its potential to provide novel molecules against diseases be explored further. Clinical trials that evaluate the efficacy and safety of extracts and isolated compounds from are recommended.
PubMed: 33763144
DOI: 10.1155/2021/5513484 -
Critical Reviews in Toxicology Jan 2021Lead is a poisonous heavy metal with various known side effects. The effect of opium on raising blood lead concentration (BLC) has been investigated with no general... (Meta-Analysis)
Meta-Analysis
Lead is a poisonous heavy metal with various known side effects. The effect of opium on raising blood lead concentration (BLC) has been investigated with no general agreement. In Iran, the number of lead poisoning cases has raised among the opium-addicted population. This systematic review and meta-analysis aim to combine the results of previous studies with the Iranian population to investigate the effect of opium on BLC. In this systematic review, PubMed/Medline, Web of Sciences, Embase, and Scopus were searched for studies using the Iranian population to compare the BLC of opium-addicted cases and non-addicted controls till January 2020. A random-effects model was used to pool the results. I-square test was used to assess the heterogeneity of the studies. The effect sizes were standardized mean differences (proxied by Hedges' ) followed by a 95% confidence interval. Of 417 initial articles, 13 studies met the inclusion criteria to be considered in the meta-analysis. The sample size of eligible studies ranged from 40 to 131 (mean 81.83, SD 27.6). All studies were focused on adults with mean age ranged from 33.5 to 65.15 years old (overall mean 49.0, SD 7.66). There were 13 studies included with 18 Hedges' effect sizes. Using a random effect model, the pooled effect size was = 2.48 (95% CI: 1.58-3.39) and statistically significant in favor of opium-addicted participants. Moreover, heterogeneity was 96.6% ( Q(17) = 504.95, < 0.001). For studies with large Hedges' g effect sizes (> 4) identified as outliers and removed from meta-analysis. The Hedges' g effect size reduced to 1.39 (95% CI: 0.94-1.85), still highly significant in favor of higher levels of lead in the opium-addicted group. The funnel plot appeared symmetrical confirmed by Egger's test ( = 1.87, = 0.088), indicating no publication bias present.
Topics: Administration, Inhalation; Adult; Aged; Humans; Iran; Lead; Lead Poisoning; Middle Aged; Opium; Opium Dependence
PubMed: 33528296
DOI: 10.1080/10408444.2020.1864722 -
International Journal of Molecular... Jan 2021The genus (Fabaceae, Subfamily, Mimosoideae) comprises about 34 species of mostly evergreen trees widely distributed across neotropics, Asia, and Africa. This review... (Meta-Analysis)
Meta-Analysis
The genus (Fabaceae, Subfamily, Mimosoideae) comprises about 34 species of mostly evergreen trees widely distributed across neotropics, Asia, and Africa. This review aims to provide an overview of the current status of the species from the genus in terms of its relationship between its phytochemistry and medical uses. Comprehensive information on species was retrieved from electronic databases, which were Web of Science, ScienceDirect, PubMed, and Google Scholar. This review identified nine species from genus with properties of medicinal use. They are used traditionally to treat several ailments, such as diabetes, diarrhea, wounds, hypertension, cough, chronic piles, conjunctivitis, and measles. The most common species studied are , , , , , , and . A considerable number of secondary metabolites, such as terpenoids, phenolic acids, flavonoids (aglycone and glycosides), and numerous volatile compounds have been identified in this genus, which are responsible for their diverse pharmacological activities. Their extracts, pure compounds and seed lectins have been reported for their anticancer, antimicrobial, antihypertensive, antiulcer, antidiabetic, anti-inflammatory, antioxidant, antimalarial, hepatoprotective, and antidiarrheal activities. The information gathered in this review might be of help for future studies in terms of the current knowledge on the link between the phytochemical components and medicinal uses. This could facilitate more discoveries on its potentials particularly in the pharmacological characteristics and potential to be developed into modern medicines.
Topics: Animals; Fabaceae; Humans; Medicine, Traditional; Phytochemicals; Phytotherapy; Plant Preparations
PubMed: 33435507
DOI: 10.3390/ijms22020618 -
Diseases of the Colon and Rectum Mar 2021Crohn's disease is a relative contraindication to IPAA due to perceived increased rates of pouch failure. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Crohn's disease is a relative contraindication to IPAA due to perceived increased rates of pouch failure.
OBJECTIVE
This study aimed to determine pouch functional outcomes and failure rates in patients with a known preoperative diagnosis of Crohn's disease.
DATA SOURCES
A database search was performed in Ovid Medline In-Process & Other NonIndexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, and Ovid Cochrane Database of Systematic Reviews.
STUDY SELECTION
The published human studies that reported short-term postoperative outcomes and/or long-term outcomes following IPAA in adult (≥18 years of age) Crohn's disease populations were selected.
INTERVENTION
Ileal pouch anal anastomoses were constructed in patients who had Crohn's disease diagnosed preoperatively or through proctocolectomy pathology.
MAIN OUTCOMES MEASURES
The primary outcomes measured were long-term functional outcomes (to maximal date of follow-up) and the pouch failure rate.
RESULTS
Of 7019 records reviewed, 6 full articles were included in the analysis. Rates of pelvic sepsis, small-bowel obstruction, pouchitis, anal stricture, and chronic sinus tract were 13%, 3%, 31%, 18%, and 28%. Rates of incontinence, urgency, pad usage in the day, pad usage at night, and need for antidiarrheals were 24%, 21%, 19%, 20%, and 28%, and mean 24-hour stool frequency was 6.3 bowel movements at a mean 69 months of follow-up. The overall pouch failure rate was 15%; no risk factors for pouch failure were identified.
LIMITATIONS
This investigation was limited by the small number of studies with significant study heterogeneity.
CONCLUSION
In patients with known preoperative Crohn's disease, IPAA construction is feasible with functional outcomes equivalent to patients with ulcerative colitis, but, even in highly selected patients with Crohn's disease, pouch failure rates remain higher than in patients with ulcerative colitis.
Topics: Adult; Anal Canal; Colitis, Ulcerative; Colonic Pouches; Constriction, Pathologic; Crohn Disease; Equipment Failure; Feasibility Studies; Fecal Incontinence; Female; Fistula; Follow-Up Studies; Humans; Intestinal Obstruction; Male; Outcome Assessment, Health Care; Postoperative Complications; Pouchitis; Preoperative Period; Proctocolectomy, Restorative; Quality of Life; Sepsis
PubMed: 33315711
DOI: 10.1097/DCR.0000000000001918 -
Biological Trace Element Research Oct 2021This meta-analysis was conducted aiming to summarize the results obtained from the previous studies so that the effect of opium on blood lead levels (BLLs) can be... (Meta-Analysis)
Meta-Analysis
This meta-analysis was conducted aiming to summarize the results obtained from the previous studies so that the effect of opium on blood lead levels (BLLs) can be investigated. Scopus, Embase, PubMed, and Web of Science (ISI) were systematically searched up to June 2020. Heterogeneity of the included studies was evaluated using Cochrane's Q test and the I statistic. A random-effects model was used to pool the weighted mean differences (WMDs) and their 95% confidence intervals (CIs). Out of a total of 2372 citations, eleven articles with 916 participants (487 opium addicts and 429 controls) were included in the study. The meta-analysis results showed that there were higher lead levels (WMD = 14.59 μg/dL, 95% CI = 11.59 to 17.92, Z = 8.60, P < 0.001) in opium addicts than in the control group. The degree of heterogeneity observed (P < 0.001, I = 98.1%) might be mainly the result of the type of sampling and of consumption. Moreover, the findings of meta-regression analyses indicated that publication year (β = 1.23, P = 0.287), total sample size (β = 0.05, P = 0.728), and quality scores (β = - 2.91, P = 0.546) had no effects on lead levels in opium addicts. In the sensitivity analysis, it was found that the pooled WMDs remained stable after excluding one by one study. Oral opium consumption increased the amount of lead in the bloodstream, and the measurement of lead levels in opium addicts' blood may be regarded as a useful test to diagnosis and prognosis of disorders that may lead poisoning causes.
Topics: Humans; Lead; Lead Poisoning; Opium
PubMed: 33244670
DOI: 10.1007/s12011-020-02504-1 -
International Journal of Surgery... Dec 2020We evaluated the efficacy and safety of probiotics for prevention of chemoradiotherapy-induced diarrhea in patients with abdominal or pelvic cancer. (Meta-Analysis)
Meta-Analysis
The efficacy and safety of probiotics for prevention of chemoradiotherapy-induced diarrhea in people with abdominal and pelvic cancer: A systematic review and meta-analysis based on 23 randomized studies.
BACKGROUND AND AIMS
We evaluated the efficacy and safety of probiotics for prevention of chemoradiotherapy-induced diarrhea in patients with abdominal or pelvic cancer.
METHODS
We searched the Cochrane Library, PubMed, EMBASE, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Wanfang, and VIP databases up to August 2019. We also hand searched the citation lists of included studies and previous systematic reviews identified to identify further relevant trials. The primary outcome was the incidence of chemoradiotherapy-induced diarrhea of all grades. The secondary outcomes were improvement of antidiarrheal medication use, stool form (Bristol scale), response rate, and adverse events (AEs). Diarrhea was graded according to the Common Toxicity Criteria system. Two reviewers assessed trial quality and extracted data independently. The included studies were analyzed using Review Manager ver. 5.2.
RESULTS
Twenty-three randomized, placebo-controlled studies (N = 2570 participants) were included in the efficacy assessment. The incidence of all diarrhea (risk ratio [RR] 0.16; 95% confidence interval [CI] 0.51-0.73), grade ≥ 3 diarrhea (RR 0.36; 95% CI 0.18-0.72), and grade ≥ 2 diarrhea (RR 0.65; 95% CI 0.54-0.78), but not that of grade ≤ 2 diarrhea (RR 1.07; 95% CI 0.95-1.21), was significantly reduced in the probiotics compared to the placebo groups. No significant increase in the incidence of AEs was found in the probiotics group, although four studies reported a variety of AEs.
CONCLUSIONS
Probiotics prevented chemoradiotherapy-induced diarrhea, particularly high-grade diarrhea. Probiotics rarely cause AEs.
Topics: Abdominal Neoplasms; Chemoradiotherapy; Diarrhea; Humans; Incidence; Pelvic Neoplasms; Probiotics; Randomized Controlled Trials as Topic
PubMed: 33080416
DOI: 10.1016/j.ijsu.2020.10.012