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PloS One 2024COVID-19 and its prevention measures have had a significant impact on patients with non-communicable diseases (NCDs) by disrupting routine healthcare service and...
BACKGROUND
COVID-19 and its prevention measures have had a significant impact on patients with non-communicable diseases (NCDs) by disrupting routine healthcare service and increasing risk factors. These challenges were expected to be more severe in sub-Saharan Africa due to the lack of physical infrastructure and inadequate resources. The quantity of studies conducted was limited, and there was a lack of published systematic reviews in the specified region. This systematic review aimed to assess the indirect impacts of the COVID-19 pandemic and associated lockdown measures on individuals with non-communicable diseases (NCDs) in sub-Saharan African countries.
METHOD
This systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and is registered with PROSPERO (ID CRD42023387755). Extensive searches were conducted in MEDLINE, EMBASE, and CINAHL databases in December 2023, supplemented by a manual search of references, grey literature, and the WHO COVID-19 database. Inclusion criteria encompassed studies that reported on the impact of COVID-19 on NCD patients in sub-Saharan African countries, focusing on access to care, health outcomes, and factors related to NCDs. Critical appraisal of study quality was performed using the Joanna Briggs Institute (JBI) analytical cross-sectional studies critical appraisal tool. Data were extracted and synthesized, highlighting the main findings and relevant limitations.
FINDINGS
This review included 30 primary studies with a cumulative sample size of 25634 participants, conducted in seven sub-Saharan African countries. These studies demonstrated that the COVID-19 pandemic significantly disrupted regular NCD patient care provision, with regional variations. The studies also identified a reduction in patient health-seeking behavior and reduced medication adherence, leading to poor treatment outcome. Furthermore, the pandemic and related lockdowns have been implicated in the increased prevalence of substance use, decreased physical exercise, and increased mental health problems.
CONCLUSION
This systematic review identified the complex challenges faced by NCD patients in sub-Saharan Africa during the COVID-19 pandemic. It also underlines the need to consider the indirect impact on vulnerable populations while developing pandemic prevention and control strategies for the future. The current NCD management strategies should prioritize the restoration of access to essential healthcare services while considering the multifaceted risks posed by decreased physical activity, poor dietary practices, and increased substance use. The main limitation of this review was the study design and setting. All of the studies included in this review employed a cross-sectional design, which may result in a low quality of evidence. This study identified research conducted in only seven countries among the 46 UN-classified sub-Saharan nations, which may impair the generalizability of the result.
Topics: COVID-19; Humans; Africa South of the Sahara; Noncommunicable Diseases; SARS-CoV-2; Pandemics
PubMed: 38905254
DOI: 10.1371/journal.pone.0293376 -
Parasitology Research Jun 2024Sterol 14-demethylase (CYP51) inhibitors, encompassing new chemical entities and repurposed drugs, have emerged as promising candidates for Chagas disease treatment,... (Meta-Analysis)
Meta-Analysis Review
Sterol 14-demethylase (CYP51) inhibitors, encompassing new chemical entities and repurposed drugs, have emerged as promising candidates for Chagas disease treatment, based on preclinical studies reporting anti-Trypanosoma cruzi activity. Triazoles like ravuconazole (RAV) and posaconazole (POS) progressed to clinical trials. Unexpectedly, their efficacy was transient in chronic Chagas disease patients, and their activity was not superior to benznidazole (BZ) treatment. This paper aims to summarize evidence on the global activity of CYP51 inhibitors against T. cruzi by applying systematic review strategies, risk of bias assessment, and meta-analysis from in vivo studies. PubMed and Embase databases were searched for original articles, obtaining fifty-six relevant papers meeting inclusion criteria. Characteristics of animal models, parasite strain, treatment schemes, and cure rates were extracted. Primary outcomes such as maximum parasitaemia values, survival, and parasitological cure were recorded for meta-analysis, when possible. The risk of bias was uncertain in most studies. Animals treated with itraconazole, RAV, or POS survived significantly longer than the infected non-treated groups (RR = 4.85 [3.62, 6.49], P < 0.00001), and they showed no differences with animals treated with positive control drugs (RR = 1.01 [0.98, 1.04], P = 0.54). Furthermore, the overall analysis showed that RAV or POS was not likely to achieve parasitological cure when compared with BZ or NFX treatment (OD = 0.49 [0.31, 0.77], P = 0.002). This systematic review contributes to understanding why the azoles had failed in clinical trials and, more importantly, how to improve the animal models of T. cruzi infection by filling the gaps between basic, translational, and clinical research.
Topics: Animals; Humans; 14-alpha Demethylase Inhibitors; Chagas Disease; Disease Models, Animal; Sterol 14-Demethylase; Thiazoles; Treatment Outcome; Triazoles; Trypanocidal Agents; Trypanosoma cruzi
PubMed: 38904688
DOI: 10.1007/s00436-024-08257-3 -
The American Journal of Drug and... Jun 2024Given the accumulating research, evolving psychosocial treatment, and equivocal findings, updating WHO's Mental Health Gap Action Programme-2015 was necessary to ensure...
Given the accumulating research, evolving psychosocial treatment, and equivocal findings, updating WHO's Mental Health Gap Action Programme-2015 was necessary to ensure guidelines reflect effective strategies for alcohol use disorder (AUD). To estimate the effects of psychosocial interventions on drinking and related outcomes. We included randomized controlled trials published between January 2015 and June 2022 on adults with alcohol dependence (ICD 10/DSM-IV) and moderate to severe AUD (DSM-5), and those examined psychosocial interventions against treatment-as-usual (TAU) and active controls. Eight databases and registries were searched. Relative Risk (RR) and standardized mean difference (SMD) were used for dichotomous and continuous outcomes. We used Cochrane's risk of bias assessment (RoB2). Of 873 screened records, 14 and 13 studies in the narrative synthesis and meta-analysis. Of the 2,575 participants, 71.5% were men. Thirteen studies used ICD 10/DSM IV diagnosis. Compared to TAU, any psychosocial intervention increased the relative risk of abstinence by 28% [ = 7, RR = 1.28, 95% CI: 1.07 to 1.53, = .01, NNT = 9]. There were minimal heterogeneity and no evidence of publication bias. Psychosocial interventions were not effective in reducing the drinking frequency ( = 2, Hedge's g = -0.10, 95% CI: -0.46 to 0.26, = .57) and drinks/drinking days ( = 5, g = -0.10, 95% CI: -0.37 to 0.16, = .43). Treatment discontinuation did not differ between intervention and control groups [RR = 1.09, 95% CI: 0.66 to 1.80]. Psychosocial interventions are effective in improving abstinence but not in reducing drinking frequency or amount. Policymakers must consider this evidence to generate AUD treatment guidelines. PROSPERO 2022 CRD42022342608.
PubMed: 38904466
DOI: 10.1080/00952990.2024.2350056 -
Clinical Colorectal Cancer Jun 2024Biliary tract carcinomas are cancers that, despite a lower prevalence compared with other gastrointestinal cancers, represent a significant public health burden due to... (Review)
Review
Treatment of Metastatic Biliary Cancers With Irinotecan and 5-Fluorouracil Based Chemotherapy After Platinum/Gemcitabine Progression: A Systematic Review and Meta-Analysis.
BACKGROUND
Biliary tract carcinomas are cancers that, despite a lower prevalence compared with other gastrointestinal cancers, represent a significant public health burden due to their aggressiveness. The metastatic stage of the disease is highly lethal and difficult to treat. Options of systemic therapies, especially beyond the first line are few and less well established.
METHODS
We performed a systematic review of literature databases to identify studies of the combination of irinotecan and 5-fluorouracil (5-FU) based chemotherapy as treatment of metastatic biliary tract carcinomas in second line, after first line treatment with platinum/gemcitabine chemotherapy. Both prospective and retrospective designs were admissible. A meta-analysis of identified studies to determine summary estimates for overall response rate (ORR), disease control rate (DCR), progression free survival (PFS) and overall survival (OS) was also performed.
RESULTS
The search was performed in PubMed/Medline and in Embase databases and identified a total of 339 articles. Manual review resulted in 8 articles that were eligible for inclusion in the meta-analysis. Second line irinotecan/5-FU based combinations produced an ORR of 9.1% (95% CI, 5.5%-12.6%) and DCR of 43.3% (95% CI, 15.8%-70.8%). Summary PFS and OS were 2.7 months (95% CI, 2.3-3.1 months) and 6.8 months (95% CI, 5.6-8.0 months), respectively. Treatments appeared to be feasible with adverse effect profiles as expected from the combination.
CONCLUSION
A moderate activity of second line irinotecan/5-FU based chemotherapy was observed in this meta-analysis. The combination is an option for patients progressing on platinum/gemcitabine chemotherapy, who maintain a sufficient general status to receive active therapy. This combination may also serve as the control arm of second line trials with new targeted agents.
PubMed: 38902137
DOI: 10.1016/j.clcc.2024.05.009 -
Clinical Nutrition ESPEN Aug 2024Diet and inflammation may contribute to the development of multiple sclerosis (MS). The aim of this systematic review and meta-analysis was to assess the association... (Meta-Analysis)
Meta-Analysis
Diet and inflammation may contribute to the development of multiple sclerosis (MS). The aim of this systematic review and meta-analysis was to assess the association between proinflammatory diet, as estimated by the Dietary Inflammatory Index (DII®), and the likelihood of developing MS or other demyelinating autoimmune diseases. A systematic search was performed of search engines and databases (PubMed, ISI Web of Sciences, Scopus, and Embase) to identify relevant studies before 10th June 2023. The search identified 182 potential studies, from which 39 full-text articles were screened for relevance. Five articles with case-control design (n = 4,322, intervention group: 1714; control group: 2608) met the study inclusion criteria. The exposure variable was DII, with studies using two distinct models: quartile-based comparisons of DII and assessment of continuous DII. The meta-analysis of high versus low quartiles of DII with four effect sizes showed a significant association with MS/demyelinating autoimmune disease likelihood, with an odds ratio (OR) of 3.26 (95% confidence interval (CI) 1.16, 9.10). The meta-analysis of four studies with DII fit as a continuous variable showed a 31% increased likelihood of MS per unit increment; which was not statistically significant at the nominal alpha equals 0.05 (OR 1.31; 95% CI 0.95, 1.81). In conclusion, this systematic review and meta-analysis provides evidence of a positive association between higher DII scores with the likelihood of developing MS, highlighting that diet-induced inflammation could play a role in MS or other demyelinating autoimmune diseases risk.
Topics: Humans; Multiple Sclerosis; Diet; Inflammation; Demyelinating Diseases; Autoimmune Diseases; Risk Factors
PubMed: 38901931
DOI: 10.1016/j.clnesp.2024.04.022 -
Archives of Physical Medicine and... Jun 2024To conduct a systematic review and meta-analysis to understand the difference in objectively measured physical activities (PA) between children with and without... (Review)
Review
OBJECTIVE
To conduct a systematic review and meta-analysis to understand the difference in objectively measured physical activities (PA) between children with and without developmental coordination disorder (DCD).
DATA SOURCES
A systematic literature search from four databases (PubMed, Science Direct, Web of Science, and Cochrane library) was conducted in July 2023.
STUDY SELECTION
Studies that met the following criteria were considered: (1) the studies should classified children with DCD based on DSM-IV, DSM-IV-TR, or DSM-V diagnosis criteria, (2) the studies aimed to evaluate PA using objective measurements and provided the amount of time spent in PA and/or SB, (3) a control group of TD children was recruited, (4) the full-text article was written in English.
DATA EXTRACTION
The following data from all included studies were extracted: the first author's surname and published year, study design, country, total sample size, the measure of PA, the intensity of PA, categories of PA level and main finding(s).
DATA SYNTHESIS
12 articles met the inclusion criteria for the systematic review, 10 of which were further entered into the meta-analysis. Overall mean difference in moderate to vigorous PA (MVPA) between two groups was -0.17 (95% CI: -0.25 to -0.09, I = 48.7%, p = 0.029). When subgroup analysis of age was further conducted (i.e., school-aged vs. preschool), a significant pooled effect size with no heterogeneity was found in school-aged children (i.e., 6-14 years old) (standardized mean difference (SMD) = -0.27, 95% CI: -0.38 to -0.16, I = 43.1%, p = 0.08).
CONCLUSIONS
Children with DCD spent significantly less time participating in MVPA, specifically those children aging between 6 and 14 years. These findings help raise the awareness for the parents and physicians toward insufficient participation in PA in children with DCD.
PubMed: 38901628
DOI: 10.1016/j.apmr.2024.06.002 -
Complementary Therapies in Clinical... Jun 2024Healthcare providers have faced challenges for patients with moderate and severe chronic obstructive pulmonary disease (COPD) in conducting their pulmonary...
BACKGROUND
Healthcare providers have faced challenges for patients with moderate and severe chronic obstructive pulmonary disease (COPD) in conducting their pulmonary rehabilitation due to dyspnea and exercise intolerance. Neuromuscular electrical stimulation (NMES) has been used to improve the muscle group's power and endurance without adding pulmonary workload, which might be used as a potential adjuvant rehabilitation method and thus to improve patients' pulmonary functions.
METHODS
This was a systematic review and meta-analysis of randomized controlled trials. Data were retrieved from PubMed, CINAHL, Academic Search Complete, Cochrane Library, and Airiti Library databases from the inception of the database to December 2022. The Cochrane Collaboration tool was used to assess the risk of bias. Two reviewers independently assessed, extracted, and appraised the included studies. Then, the grading of recommendations, assessment, development, and evaluation (GRADE) methodology was used for assessing the certainty of evidence. The pooled estimates were calculated using a random-effects model.
RESULTS
In total, 19 studies involving 589 moderate to severe COPD patients were analyzed. Compared with controls, adding NMES to pulmonary rehabilitation could significantly increase exercise capacity, physical activity function, and health-related quality of life (HRQoL) (all p < 0.05). The GRADE results showed low to very low certainty of evidence levels.
CONCLUSION
NMES could improve exercise capacity and reduce the perceived sensation of dyspnea during exercise and is recommended as an effective adjuvant training modality in the rehabilitation for moderate to severe COPD patients.
PubMed: 38901395
DOI: 10.1016/j.ctcp.2024.101867 -
Sports Medicine (Auckland, N.Z.) Jun 2024The effect of swimming on bone health remains unclear, namely due to discrepant findings between studies in humans and animal models.
BACKGROUND
The effect of swimming on bone health remains unclear, namely due to discrepant findings between studies in humans and animal models.
OBJECTIVE
The aim of this systematic review and meta-analysis is to identify the available evidence on the effects of swimming on bone mass, geometry and microarchitecture at the lumbar spine, femur and tibia in both humans and rodent animal models.
METHODS
The study followed PRISMA guidelines and was registered at PROSPERO (CRD4202236347 and CRD42022363714 for human and animal studies). Two different systematic literature searches were conducted in PubMed, Scopus and Web of Science, retrieving 36 and 16 reports for humans and animal models, respectively.
RESULTS
In humans, areal bone mineral density (aBMD) was similar between swimmers and non-athletic controls at the lumbar spine, hip and femoral neck. Swimmers' tibia diaphysis showed a higher cross-sectional area but lower cortical thickness. Inconsistent findings at the femoral neck cortical thickness were found. Due to the small number of studies, trabecular microarchitecture in human swimmers was not assessed. In rodent models, aBMD was found to be lower at the tibia, but similar at the femur. Inconsistent findings in femur diaphysis cross-sectional area were observed. No differences in femur and tibia trabecular microarchitecture were found.
CONCLUSION
Swimming seems to affect bone health differently according to anatomical region. Studies in both humans and rodent models suggest that tibia cortical bone is negatively affected by swimming. There was no evidence of a negative effect of swimming on other bone regions, both in humans and animal models.
PubMed: 38900358
DOI: 10.1007/s40279-024-02052-x -
Frontiers in Pharmacology 2024As a bioactive metabolite preparation widely used in acute ischemic stroke (AIS), the efficacy and safety of saponins injections (PNSI) in patients with AIS after...
BACKGROUND
As a bioactive metabolite preparation widely used in acute ischemic stroke (AIS), the efficacy and safety of saponins injections (PNSI) in patients with AIS after intravenous thrombolysis remain to be evaluated.
METHODS
This study included randomized controlled trials published before 26 April 2024 in 8 databases. AIS patients who received intravenous thrombolysis were included. The control group receiving conventional treatment and the treatment group receiving additional PNSI. Primary outcomes were selected as mortality, disability, and adverse events. Secondary outcomes were selected as all-cause mortality, improvement of neurological deficit, quality of life, and cerebral injury indicators. The revised Cochrane Risk of Bias tool was used to assess risk of bias. Risk ratio (RR) and mean differences (MD) were calculated for binary variables and continuous variables, respectively, based on a 95% confidence interval (CI).
RESULTS
A total of 20 trials involving 1,856 participants were included. None of them reported mortality or disability. There was no significant difference in the adverse events [RR: 1.04; 95% CI: 0.60 to 1.81] and hemorrhagic transformation [RR: 0.99; 95% CI: 0.36 to 2.70] between the two groups. Compared to the control group, the treatment group had a better effect in neurological improvement assessed by National Institutes of Health Stroke Scale [MD: -2.91; 95% CI: -4.76 to -1.06], a better effect in activities of daily living changes in Barthel Index [MD: 9.37; 95% CI: 1.86 to 16.88], and a lower serum neuron-specific enolase level [MD: -2.08; 95% CI: -2.67 to -1.49].
CONCLUSION
For AIS patients undergoing intravenous thrombolysis, the use of PNSI improved neurological deficits and enhanced activity of daily living in the short term without increasing the occurrence rate of adverse events. However, due to the moderate to very low certainty of evidence, it is advisable to conduct high-quality clinical trials to validate the findings of this study.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=466851, Identifier CRD42023466851.
PubMed: 38898926
DOI: 10.3389/fphar.2024.1376025 -
Frontiers in Pharmacology 2024Intracerebral haemorrhage (ICH) is the deadliest subtype of stroke. Surgery remains a vital measure for life-saving in emergency situations, however, the recovery of...
BACKGROUND
Intracerebral haemorrhage (ICH) is the deadliest subtype of stroke. Surgery remains a vital measure for life-saving in emergency situations, however, the recovery of post-operative patients is not optimistic. This study aimed to evaluate the evidence of the efficacy and safety of Xingnaojing injection (XNJ) for post-operative patients of ICH.
METHODS
From inception to 31 January 2024, we searched eight representative databases for randomized controlled trials on post-operative patients of ICH treated with XNJ. A meta-analysis was conducted using R4.2.2, and the quality of the evidence was evaluated by GRADE criteria.
RESULTS
The results indicated that the combination of XNJ with conventional western medicine therapy improved the total efficiency rate (RR = 1.26; 95% CI [1.21 to 1.32]; < 0.0001), reduced the all-cause mortality within 15 days (RR = 0.45; 95% CI [0.30 to 0.67]; < 0.0001), decreased the volume of hematoma (MD = -4.72; 95% CI [-7.43 to -2.01]; = 0.0006) and perihematomal edema (MD = -4.11; 95% CI [-8.11 to -0.11]; = 0.0441), reduced the TNF-α levels (SMD = -1.61, 95% CI [-2.23 to -0.99], < 0.0001), decreased neurological impairment (SMD = -1.44; 95% CI [-1.78 to -1.11]; < 0.0001), improved the activities of daily living (SMD = 1.22; 95% CI [0.78 to 1.66]; < 0.0001), and enhanced the consciousness level (MD = 2.08, 95% CI [1.22 to 2.93], < 0.0001). In addition, the complications of the combination therapy group were lower (RR = 0.43; 95% CI [0.35 to 0.54]; < 0.0001) and the adverse drug reactions were comparable to the control group (RR = 0.89; 95% CI [0.55 to 1.45]; = 0.6521). The trial sequential analysis results showed that the sample size is sufficient.
CONCLUSION
Current evidence indicates that XNJ can enhance the efficiency, reduce mortality, and lower the incidence of complications, while demonstrating good tolerability of post-operative patients of ICH. However, the level of evidence from existing studies is relatively weak, and only prove short-term effects, and high-quality RCTs are needed to further verify the accuracy of these conclusions. identifier (PROSPERO 2024 CRD42024503006). https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024503006, Identifier CRD42024503006.
PubMed: 38898923
DOI: 10.3389/fphar.2024.1411026