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Alimentary Pharmacology & Therapeutics Feb 2009Pancreatic enzyme supplementation is standard treatment for malabsorption caused by chronic pancreatitis. The FDA recently required all manufacturers to submit New Drug... (Review)
Review
BACKGROUND
Pancreatic enzyme supplementation is standard treatment for malabsorption caused by chronic pancreatitis. The FDA recently required all manufacturers to submit New Drug Applications to continue to market these agents because published data demonstrated variation in formulation, bioavailability and shelf-life while providing limited data about efficacy and safety.
AIM
To review systematically the design and results of randomized, parallel-design trials of pancreatic enzyme supplements in chronic pancreatitis patients with steatorrhea.
METHODS
A computer-assisted search of MEDLINE and EMBASE was performed to identify relevant studies. Two authors performed duplicate data extraction on study design, improvement in coefficient of fat absorption (CFA), diarrhoea and adverse events using pre-specified forms. Agreement between investigators for data extraction was greater than 95%.
RESULTS
Of 619 articles found through literature searching, 20 potentially relevant articles were identified and four manuscripts met inclusion criteria. No studies performed head-to-head comparisons of different supplements. Enzyme supplementation is more likely to improve CFA compared with placebo, but fat malabsorption remained abnormal. Important differences in patient population, study endpoint, study design, pancreatic enzyme dosage and measurement of CFA were present across trials, which precluded comparison of different agents.
CONCLUSIONS
Enzyme supplementation improves CFA compared to placebo, but may not abolish steatorrhoea.
Topics: Amylases; Biological Availability; Cystic Fibrosis; Enzyme Therapy; Feces; Female; Humans; Lipase; Malabsorption Syndromes; Male; Pancreatitis, Chronic; Peptide Hydrolases; Randomized Controlled Trials as Topic
PubMed: 19035969
DOI: 10.1111/j.1365-2036.2008.03885.x -
Evidence-based Complementary and... 2014Background. Reflexology is one of the top forms of complementary and alternative medicine in the UK and is used for healthcare by a diverse range of people. However, it... (Review)
Review
Background. Reflexology is one of the top forms of complementary and alternative medicine in the UK and is used for healthcare by a diverse range of people. However, it is offered by few healthcare providers as little scientific evidence is available explaining how it works or any health benefits it may confer. The aim of this review was to assess the current evidence available from reflexology randomised controlled trials (RCTs) that have investigated changes in physiological or biochemical outcomes. Methods. Guidelines from the Cochrane Handbook of Systematic Reviews of Interventions were followed: the following databases were searched from inception to December 2013: AMED, CAM Quest, CINAHL Plus, Cochrane Central Register of Controlled Trials, Embase, Medline Ovid, Proquest, and Pubmed. Risk of bias was assessed independently by two members of the review team and overall strength of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation guidelines. Results. Seventeen eligible RCTs met all inclusion criteria. A total of 34 objective outcome measures were analysed. Although twelve studies showed significant changes within the reflexology group, only three studies investigating blood pressure, cardiac index, and salivary amylase resulted in significant between group changes in favour of reflexology. The overall quality of the studies was low.
PubMed: 24883067
DOI: 10.1155/2014/502123 -
World Journal of Gastroenterology Aug 2015To investigate the efficacy and adverse effects of antioxidant therapy in acute pancreatitis (AP), chronic pancreatitis (CP) and post-endoscopic retrograde... (Meta-Analysis)
Meta-Analysis Review
AIM
To investigate the efficacy and adverse effects of antioxidant therapy in acute pancreatitis (AP), chronic pancreatitis (CP) and post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP).
METHODS
PubMed, Scopus, Google Scholar, Cochrane library database, and Evidence-based medicine/clinical trials published before August 2014 were searched. Clinical and laboratory outcomes of randomized trials of antioxidant therapy in patients with AP, CP and PEP were included. The methodological quality of the trials was assessed by the Jadad score based on the description of randomization, blinding, and dropouts (withdrawals). The results of the studies were pooled and meta-analyzed to provide estimates of the efficacy of antioxidant therapy.
RESULTS
Thirty four trials out of 1069 potentially relevant studies with data for 4898 patients were eligible for inclusion. Antioxidant therapy significantly reduced the length of hospital stay in AP patients {mean difference -2.59 d (95%CI: -4.25-(-0.93)], P = 0.002}. Although, antioxidant therapy had no significant effect on serum C reactive protein (CRP) after 5-7 d in AP patients [mean difference -9.57 (95%CI: -40.61-21.48, P = 0.55], it significantly reduced serum CRP after 10 d {mean difference -45.16 [95%CI: -89.99-(-0.33)], P = 0.048}. In addition, antioxidant therapy had no significant effect on CP-induced pain [mean difference -2.13 (95%CI: -5.87-1.6), P = 0.26]. Antioxidant therapy had no significant effects on the incidence of all types of PEP [mean difference 1.05 (95%CI: 0.74-1.5), P = 0.78], severe PEP [mean difference 0.92 (95%CI: 0.43-1.97), P = 0.83], moderate PEP [mean difference 0.82 (95%CI: 0.54-1.23), P = 0.33], and mild PEP [mean difference 1.33 (95%CI: 0.99-1.78), P = 0.06]. Furthermore, while antioxidant therapy had no significant effect on serum amylase after less than 8 h sampling [mean difference -20.61 (95%CI: -143.61-102.39), P = 0.74], it significantly reduced serum amylase close to 24-h sampling {mean difference -16.13 [95%CI: -22.98-(-9.28)], P < 0.0001}.
CONCLUSION
While there is some evidence to support antioxidant therapy in AP, its effect on CP and PEP is still controversial.
Topics: Abdominal Pain; Acute Disease; Antioxidants; Biomarkers; C-Reactive Protein; Cholangiopancreatography, Endoscopic Retrograde; Humans; Inflammation Mediators; Length of Stay; Pancreatitis; Pancreatitis, Chronic; Severity of Illness Index; Treatment Outcome
PubMed: 26290647
DOI: 10.3748/wjg.v21.i30.9189 -
Frontiers in Pharmacology 2022At present, a number of systematic reviews (SRs) on Xuebijing injection (a patent in China) in the treatment of acute pancreatitis (AP) or severe acute pancreatitis...
At present, a number of systematic reviews (SRs) on Xuebijing injection (a patent in China) in the treatment of acute pancreatitis (AP) or severe acute pancreatitis (SAP) have been published. However, the quality of evidence is uneven and has not been comprehensively evaluated. We evaluated the efficacy of Xuebijing injection for AP/SAP through an overview of SR, and to provide a scientific basis for its effectiveness and safety. We searched Cochrane Library, Embase, PubMed, SinoMed, CNKI, Wanfang, and VIP comprehensively. The retrieval period from inception to 30 November 2021, and the two reviewers independently complete the literature retrieval, data extraction and evaluation. The Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2) and the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA) were used to evaluate the methodological quality and reporting quality of the SRs, respectively. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool was used to evaluate the quality grading of outcomes and the risk of bias in SRs was evaluated by ROBIS Tool. Finally, the RCTs involved in SRs were synthesized. Stata15.1 was used for quantitative analysis of total effectiveness rate, time until relief of abdominal pain, time until relief of abdominal distension, and serum amylase level. Nine eligible SRs were included, including 92 RCTs and 6,837 participants. The quality of SRs was relatively good, and the manuscript structures were relatively complete. However, the methodological quality of SRs was low or critically low. RoB rated 5 SRs as low risk of bias and 4 SRs as high risk of bias. In GRADE, a total of 47 results were included in the 9 SRs, of which 5 results (10.64%) were moderate quality, 22 results (46.81%) were low quality, and 20 results (42.55%) were very low quality. The results of data synthesis showed that Xuebijing injection combined treatment increased the total effectiveness rate of AP patients (RR = 1.19, 95% CI 1.17-1.23, < 0.0001), and there was no heterogeneity between studies (I = 0.0%, = 0.589). Compared with the control group, Xuebijing injection group shortened the abdominal pain and distension relief time in AP patients (WMD = -1.69, 95% CI -1.88--1.50, < 0.0001; WMD = -1.48, 95% CI -1.74--1.23, < 0.0001), with high heterogeneity (I = 84.3%, = 0.000; I = 72.2%, = 0.000). Serum amylase level was also reduced (WMD = -2.06, 95% CI -2.47--1.64, < 0.0001), with significant heterogeneity (I = 71.6%, = 0.000). A total of one SR reported adverse drug reaction (ADR), no ADRs were observed in the control group. Although the quality of the evidence is not high, it can still reflect the clinical value of Xuebijing injection as an analgesic and anti-inflammatory traditional Chinese medicine in the treatment of AP/SAP. Therefore, future clinical studies should focus on the long-term efficacy and adverse reactions of drugs. (website), identifier (registration number).
PubMed: 36034818
DOI: 10.3389/fphar.2022.883729 -
Journal of Clinical Medicine Nov 2019Anastomotic leakage (AL) following gastroesophageal cancer surgery remains a serious postoperative complication. This systematic review aims to provide an overview of... (Review)
Review
Anastomotic leakage (AL) following gastroesophageal cancer surgery remains a serious postoperative complication. This systematic review aims to provide an overview of investigated biomarkers for the early detection of AL following esophagectomy, esophagogastrectomy and gastrectomy. All published studies evaluating the diagnostic accuracy of biomarkers predicting AL following gastroesophageal resection for cancer were included. The Embase, Medline, Cochrane Library, PubMed and Web of Science databases were searched. Risk of bias and applicability were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) 2 tool. Twenty-four studies evaluated biomarkers in the context of AL following gastroesophageal cancer surgery. Biomarkers were derived from the systemic circulation, mediastinal and peritoneal drains, urine and mediastinal microdialysis. The most commonly evaluated serum biomarkers were C-reactive protein and leucocytes. Both proved to be useful markers for excluding AL owing to its high specificity and negative predictive values. Amylase was the most commonly evaluated peritoneal drain biomarker and significantly elevated levels can predict AL in the early postoperative period. The associated area under the receiver operating characteristic (AUROC) curve values ranged from 0.482 to 0.994. Current biomarkers are poor predictors of AL after gastroesophageal cancer surgery owing to insufficient sensitivity and positive predictive value. Further research is needed to identify better diagnostic tools to predict AL.
PubMed: 31744186
DOI: 10.3390/jcm8112005 -
Heliyon Mar 2020Natural resources provide more efficient and safer alternatives in managing diabetes compare to the synthetic oral anti diabetes (OAD). The plants not only have... (Review)
Review
BACKGROUND
Natural resources provide more efficient and safer alternatives in managing diabetes compare to the synthetic oral anti diabetes (OAD). The plants not only have hypoglycemic effect, but also prevent its complications; in which no synthetic drugs provide of both properties. Among antidiabetes plants, mahogany seed () has been used as traditional medicine in Indonesia and India, though most popular utilized as timber wood.
METHODS
The present study was performed of chemotaxonomic approach to review its phytochemical and anti-diabetic properties of (L.) Jacq seed/bark/leaves. The qualitative systematic review (SR) was carried out by analysing indexed journals and peer reviewed of and spp from Scopus, PubMed, Medline, Google Scholar, and Research Gate. Data selection criteria are accordance to botany, phytochemistry, , , and clinical test of related subject. The keywords used for the search in the databases were , mahagony, diabetes, and diabetes plants.
RESULTS
(L.) Jacq. extracts have shown , and limited clinically test of its anti-diabetic properties. Ethanolic/methanolic/aqueous/petroleum/n-hexane extracts of mahagonis's seed/bark or leaves have anti-diabetic activities comparable to the synthetic drug and observed no to relatively mild toxic effect. The hypoglycemic mechanism suggested via reducing blood glucose level, restoring liver and -cells islet function (might) blocking epinephrine function, inhibiting of -amylase and -glucosidase, antioxidant and antihiperlipidemia. Phytochemical compounds of consist of the phenolics (flavonoids (swietemacrophyllanin, catechins and epichatechins) and tannins), triterpenoids and tetranortriterpenoids (limonoids: mahonin, secomahoganin, swietmanins, swiemahogins, swietenine and swietenolide), saponins and alkaloids which are known as anti-diabetic bioactive principles.
CONCLUSION
was potentially used and developed as an antidiabetes source. To use it as an antidiabetic further, more extensive clinical trials and biomarkers of active compounds determination are needed.
PubMed: 32190758
DOI: 10.1016/j.heliyon.2020.e03536 -
Food Science & Nutrition Mar 2024Diet is a modifiable risk factor in the prevention and management of obesity, and various foods have the potential to aid in obesity management by modulating different... (Review)
Review
Diet is a modifiable risk factor in the prevention and management of obesity, and various foods have the potential to aid in obesity management by modulating different pathways involved in the disease's pathology. We performed a systematic review of literature, using CINAHL, PubMed, and Google Scholar, focusing on the antiobesity potential of foods crops and functional food products, and their mechanisms of action and clinical evidence. Sixty-four articles were identified, of which 41 investigated food crops, while 23 investigated functional products. Food crops, such as cereals, vegetables, fruits, mushrooms, seaweeds, legumes, herbs, spices, and cocoa seeds, have antiobesity effects through mechanisms such as altering the metabolism of glucolipids by inhibiting enzymes like α-amylase and α-glucosidase, stimulating the bioenergetics of thermogenic fat, modulating gut microbiota, and inhibiting lipogenesis and storage. In addition, developed functional teas, beverages, and yoghurt have antiobesity effects through similar or different mechanisms, such as enhancing energy expenditure and satiety, suppressing adipogenesis and lipolysis, improving glucose and lipid metabolism, and altering hormonal secretion. This review reemphasized the significance of food in the control of obesity, and highlights the distinct methods these explored foods exert their antiobesity effects. In conclusion, foods are safe and effective means of combating obesity without the side effects of conventional drugs, which can help inform dietary choices, assist professionals in providing more accurate advice, and also lead to better understanding of food and its effect on overall health of the public. This approach will eradicate global diseases, especially if more underutilized and indigenous food crops are extensively researched.
PubMed: 38455221
DOI: 10.1002/fsn3.3856 -
Evidence-based Complementary and... 2019Available data indicate that diabetes mellitus leads to elevated cost of healthcare. This imposes a huge economic burden on households, societies, and nations. As a... (Review)
Review
BACKGROUND
Available data indicate that diabetes mellitus leads to elevated cost of healthcare. This imposes a huge economic burden on households, societies, and nations. As a result many Ghanaians, especially rural folks, resort to the use of phytomedicine, which is relatively less expensive. This paper aims at obtaining information on plants used in Ghana to treat diabetes mellitus, gather and present evidence-based data available to support their uses and their mechanisms of action, and identify areas for future research.
METHOD
A catalogue of published textbooks, monographs, theses, and peer-reviewed articles of plants used in Ghanaian traditional medicine between 1987 and July 2018 for managing diabetes mellitus was obtained and used.
RESULTS
The review identified 76 plant species belonging to 45 families that are used to manage diabetes mellitus. Leaves were the part of the plants frequently used for most preparation (63.8%) and were mostly used as decoctions. Majority of the plants belonged to the Euphorbiaceae, Lamiaceae, Asteraceae, and Apocynaceae families. Pharmacological data were available on 23 species that have undergone studies. Forty species have been studied using animal models. Only twelve plants and their bioactive compounds were found with data on both preclinical and clinical studies. The records further indicate that medicinal plants showing antidiabetic effects did so via biochemical mechanisms such as restitution of pancreatic -cell function, improvement in insulin sensitivity by receptors, stimulating rate of insulin secretion, inhibition of liver gluconeogenesis, enhanced glucose absorption, and inhibition of G-6-Pase, -amylase, and -glucosidase activities.
CONCLUSION
This review contains information on medicinal plants used to manage diabetes mellitus, including their pharmacological properties and mechanisms of action as well as models used to investigate them. It also provides gaps that can form the basis for further investigations and development into useful medications for effective treatment of diabetes mellitus.
PubMed: 31118963
DOI: 10.1155/2019/6021209 -
Diagnostics (Basel, Switzerland) May 2021The aim of this study was to perform a systematic review on the potential value of saliva biomarkers in the diagnosis, management and prognosis of heart failure (HF).... (Review)
Review
The aim of this study was to perform a systematic review on the potential value of saliva biomarkers in the diagnosis, management and prognosis of heart failure (HF). The correlation between saliva and plasma values of these biomarkers was also studied. PubMed was searched to collect relevant literature, i.e., case-control, cross-sectional studies that either compared the values of salivary biomarkers among healthy subjects and HF patients, or investigated their role in risk stratification and prognosis in HF patients. No randomized control trials were included. The search ended on 31st of December 2020. A total of 15 studies met the inclusion criteria. 18 salivary biomarkers were analyzed and the levels of all biomarkers studied were found to be higher in HF patients compared to controls, except for amylase, sodium, and chloride that had smaller saliva concentrations in HF patients. Natriuretic peptides are the most commonly used plasma biomarkers in the management of HF. Their saliva levels show promising results, although the correlation of saliva to plasma values is weakened in higher plasma values. In most of the publications, differences in biomarker levels between HF patients and controls were found to be statistically significant. Due to the small number of patients included, larger studies need to be conducted in order to facilitate the use of saliva biomarkers in clinical practice.
PubMed: 34063278
DOI: 10.3390/diagnostics11050824 -
Clinics and Research in Hepatology and... 2020Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently given to patients with acute pancreatitis (AP) for controlling pain, but their efficacy in treating AP,...
BACKGROUND
Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently given to patients with acute pancreatitis (AP) for controlling pain, but their efficacy in treating AP, particularly in reducing systemic complications, remains unclear.
AIM
The aim of our study was to evaluate the efficacy of NSAIDs in treating AP and its systematic complications.
METHODS
Two independent reviewers screened articles from MEDLINE, Embase and Cochrane and scored the quality of each study according to the CAMARADES 10-item quality checklist or the Jadad scale. Five endpoints were chosen to evaluate the effect of NSAIDs in animal studies: amylase and lipase levels, proinflammatory cytokines, oxidative damage, histopathological changes, and mortality rate. Meanwhile, in clinical studies, endpoints, such as proinflammatory cytokines, pain relief, systematic complications, mortality, and adverse events were used.
RESULTS
A total of 36 studies out of 17,845 were identified and included. Of these 36 studies, only 5 were clinical trials involving 580 patients, and the remaining 31 were animal studies with 1623 rats or mice. 24 studies focused on the treatment of AP with NSAIDs and 12 on AP-associated systematic complications. Both preclinical and clinical studies showed that NSAIDs may have beneficial effects against AP-related injuries. 9 of the 14 preclinical studies stated that NSAIDs reduced the serum amylase level significantly, and 6 of 7 showed that NSAIDs lowered the lipase level markedly. 17 experimental studies all demonstrated that NSAIDs reduced the inflammation. Histopathological examinations indicated that NSAIDs significantly improved the histopathological damages. Similarly, clinical evidence showed that NSAIDs are effective in suppressing proinflammatory cytokines, relieving pain, ameliorating systematic complications and reducing mortality. In the included 5 clinical studies, serious adverse events associated with NSAIDs were rarely reported.
CONCLUSION
This systematic review shows that NSAIDs are a potential treatment for AP-related injuries based on the current preclinical and clinical evidences.
Topics: Amylases; Animals; Anti-Inflammatory Agents, Non-Steroidal; Clinical Trials as Topic; Humans; Inflammation Mediators; Lipase; Mice; Mortality; Pain; Pancreatitis; Rats
PubMed: 33602483
DOI: 10.1016/j.clirex.2019.100002