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Frontiers in Immunology 2022Rheumatoid arthritis (RA), one of the most common immune system diseases, mainly affects middle-aged and elderly individuals and has a serious impact on the quality of... (Review)
Review
Rheumatoid arthritis (RA), one of the most common immune system diseases, mainly affects middle-aged and elderly individuals and has a serious impact on the quality of life of patients. Pain and disability caused by RA are significant symptoms negatively affecting patients, and they are especially seen when inappropriate treatment is administered. Effective therapeutic strategies have evolved over the past few decades, with many new disease-modifying antirheumatic drugs (DMARDs) being used in the clinic. Owing to the breakthrough in the treatment of RA, the symptoms of patients who could not be treated effectively in the past few years have been relieved. However, some patients complain about symptoms that have not been reported, implying that there are still some limitations in the RA treatment and evaluation system. In recent years, biomarkers, an effective means of diagnosing and evaluating the condition of patients with RA, have gradually been used in clinical practice to evaluate the therapeutic effect of RA, which is constantly being improved for accurate application of treatment in patients with RA. In this article, we summarize a series of biomarkers that may be helpful in evaluating the therapeutic effect and improving the efficiency of clinical treatment for RA. These efforts may also encourage researchers to devote more time and resources to the study and application of biomarkers, resulting in a new evaluation system that will reduce the inappropriate use of DMARDs, as well as patients' physical pain and financial burden.
Topics: Aged; Antirheumatic Agents; Arthritis, Rheumatoid; Biomarkers; Drug-Related Side Effects and Adverse Reactions; Humans; Middle Aged; Pain; Quality of Life
PubMed: 35418971
DOI: 10.3389/fimmu.2022.865267 -
Multifunctional co-transport carriers based on cyclodextrin assembly for cancer synergistic therapy.Theranostics 2022In the past few years, drug delivery systems have been used extensively to improve solubility, stability, and pharmacokinetics of chemotherapeutic drugs. However,... (Review)
Review
In the past few years, drug delivery systems have been used extensively to improve solubility, stability, and pharmacokinetics of chemotherapeutic drugs. However, traditional delivery systems fail to fulfill the required standard of effectiveness, primarily owing to issues of drug resistance exhibited by cancer cells and inherent differences among the patients. In this regard, combination therapy offers advantages of synergistic mechanism, reduced drug dosage, and enhanced therapeutic effect, which can be effectively utilized for the treatment of cancer. However, different types of therapeutic agents exhibit different pharmacokinetic properties and action targets , which lead to uncontrollable concentration ratio of therapeutic agents at the lesion site. This in turn causes serious side effects and affects synergistic anticancer effect. Importantly, multifunctional co-delivery systems are characterized by good pharmacokinetic properties, ability to provide targeted delivery, and controlled release in response to tumor microenvironment. Such delivery systems are widely used for co-delivery of therapeutic agents, which further assist in obtaining better synergistic anticancer effect, and can be potentially used for clinical application. Multifunctional co-delivery systems often exhibit complex structures and construction process. Since cyclodextrin is characterized by self-assembly property, it is possible to quickly construct cyclodextrin-based multifunctional co-delivery systems, with convenience and flexibility. The application of cyclodextrin in the construction of multifunctional co-delivery systems for cancer therapy has gained immense attention in the past few years. The present study provided overview of latest progress in the field of cyclodextrin-based multifunctional co-delivery systems for cancer synergistic therapy.
Topics: Antineoplastic Agents; Combined Modality Therapy; Cyclodextrins; Drug Carriers; Drug Delivery Systems; Humans; Nanoparticles; Neoplasms; Tumor Microenvironment
PubMed: 35401819
DOI: 10.7150/thno.70243 -
Bioactive Materials Jan 2022Interventional coronary reperfusion strategies are widely adopted to treat acute myocardial infarction, but morbidity and mortality of acute myocardial infarction are... (Review)
Review
Interventional coronary reperfusion strategies are widely adopted to treat acute myocardial infarction, but morbidity and mortality of acute myocardial infarction are still high. Reperfusion injuries are inevitable due to the generation of reactive oxygen species (ROS) and apoptosis of cardiac muscle cells. However, many antioxidant and anti-inflammatory drugs are largely limited by pharmacokinetics and route of administration, such as short half-life, low stability, low bioavailability, and side effects for treatment myocardial ischemia reperfusion injury. Therefore, it is necessary to develop effective drugs and technologies to address this issue. Fortunately, nanotherapies have demonstrated great opportunities for treating myocardial ischemia reperfusion injury. Compared with traditional drugs, nanodrugs can effectively increase the therapeutic effect and reduces side effects by improving pharmacokinetic and pharmacodynamic properties due to nanodrugs' size, shape, and material characteristics. In this review, the biology of ROS and molecular mechanisms of myocardial ischemia reperfusion injury are discussed. Furthermore, we summarized the applications of ROS-based nanoparticles, highlighting the latest achievements of nanotechnology researches for the treatment of myocardial ischemia reperfusion injury.
PubMed: 34466716
DOI: 10.1016/j.bioactmat.2021.06.006 -
Indian Journal of Psychological Medicine 2016Data on effect of clozapine on metabolic syndrome in adolescent patients with psychosis are limited. This study aimed to evaluate the prevalence and incidence of...
INTRODUCTION
Data on effect of clozapine on metabolic syndrome in adolescent patients with psychosis are limited. This study aimed to evaluate the prevalence and incidence of metabolic syndrome in children and adolescents with psychotic disorders prior to clozapine and while receiving clozapine. Secondary aims were to study the effectiveness and side effect profile of clozapine.
MATERIALS AND METHODS
Thirteen child and adolescent patients were evaluated at baseline, 3 months, and a follow-up beyond 6 months. Assessments were made for metabolic profile, effectiveness by positive and negative syndrome scale (PANSS), and side effects.
RESULTS
Prior to starting of clozapine, the prevalence of metabolic syndrome was 23%. After 3 months on clozapine, 38.5% (5/13) patients fulfilled criteria of metabolic syndrome and further on follow-up beyond 6 months (with last observation carried forward) 46.2% (6/13) had developed metabolic syndrome. There was a significant reduction in PANSS scores at 3 months and follow-up more so in those who developed metabolic syndrome at 3 months. Among the other side effects, hypersalivation was the most common side effect (100%) followed by sedation (69%).
CONCLUSION
Half the prevalence of metabolic syndrome in adolescents on clozapine can be attributed to other factors prior to starting of clozapine, and another half can be attributed to clozapine. Clozapine is effective in an adolescent population.
PubMed: 27335518
DOI: 10.4103/0253-7176.183091 -
Frontiers in Cellular and Infection... 2023Probiotics has been reported as an effective supplement for Helicobacter pylori eradication. However, knowledge of their comparative efficacy is still lacking. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Probiotics has been reported as an effective supplement for Helicobacter pylori eradication. However, knowledge of their comparative efficacy is still lacking.
AIM
In this study, we used network meta-analysis of current probiotics supplement used in standard triple therapy to assess and rank their comparative effectiveness.
METHODS
All randomized controlled trials from three main databases (PubMed, Embase and Cochrane Library) up to April 2022 were collected and filtered to meet our criterion. We used Bayesian network meta-analysis to evaluate the eligible randomized controlled trials and gave a rank for the efficiency and incidence of side effects of each probiotics supplement. The ranking probability for each therapy was assessed by means of surfaces under cumulative ranking values. Subgroup analysis was conducted to evaluate other possible influencing factors.
RESULTS
34 eligible randomized controlled trials entered the following meta-analysis, including 9,004 patients randomized to 10 kinds of therapies. Result showed that most probiotics added therapies had better outcomes than triple therapy, among which Bifidobacterium-Lactobacillus and Bifidobacterium-Lactobacillus-Saccharomyces adjuvant therapy could obtain comprehensive benefit with high eradication rate (78.3% and 88.2% respectively), and cause few side effects. Combination of different probiotics, adding probiotics before or after triple therapy and longer duration of probiotics can improve therapeutic effect in infected individuals.
CONCLUSION
For triple therapy of infection, adding probiotics can increase eradication rate and bring protective effect. Considering the overall influence, Bifidobacterium-Lactobacillus or Bifidobacterium-Lactobacillus-Saccharomyces therapy can be a better choice in improving eradication process.
Topics: Humans; Helicobacter pylori; Network Meta-Analysis; Bayes Theorem; Probiotics; Dietary Supplements; Helicobacter Infections; Anti-Bacterial Agents; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 37256113
DOI: 10.3389/fcimb.2023.1120789 -
Sisli Etfal Hastanesi Tip Bulteni 2020Clobazam is a long-acting antiepileptic drug that belongs to benzodiazepines used in the polytherapy of childhood epilepsy. In this study, our aim is to retrospectively...
OBJECTIVES
Clobazam is a long-acting antiepileptic drug that belongs to benzodiazepines used in the polytherapy of childhood epilepsy. In this study, our aim is to retrospectively evaluate the effectiveness and side effect profile of clobazam in children with different etiologies of epilepsy, mostly drug resistant.
METHODS
Forty patients aged 0-18 years that were admitted to Okmeydanı Training and Research Hospital pediatric neurology outpatient clinic between January 2017-January 2019 and prescribed clobazam were included in this study. The data of the patients who gave informed consent were extracted retrospectively from the outpatient clinic files. The patients with no seizures over 50% reduction in seizures were classified as clobazam-responsive, whereas the patients with less than 50% reductions in seizures, patients who had no response, and who manifested side effects and stopped using the drug were classified as clobazam-unresponsive.
RESULTS
Twenty-three of the patients (57.5%) were male, 17 were (42.5%) were female. The average onset age of epilepsy was 31.8±37.2 months, while the average age for the prescription of clobazam was 70.6±48.9 months. The types of seizures were focal in 23 patients (57.5%) and generalized in 17 (42.5%) patients. Thirty-three (82.5%) patients had been using double or triple combinations of eight different antiepileptic drugs when clobazam was added to their treatment and accepted as drug-resistant epilepsy. The etiology of twenty one patients (52.5%) was unknown. In the remaining 19 patients (47.5%), the most common cause was structural and others were genetic, infectious and metabolic. Thirty one of the patients (77.5%) were responsive to clobazam. Of them, fifteen (37.5%) had no seizures, and 16 had a reduction in seizures (>50%). Nine (22.5%) patients were accepted as unresponsive to clobazam. The mean dose per kg was 0.7±0.3 mg/kg/day with a median of 0.63 mg/kg/day. Side effects of clobazam were encountered in 18 patients (45%); these resulted in the cessation of administration in only six (15%) patients. The side effects that cause the cessation of clobazam were sedation, refusal to take the drug due to the taste, irritability, hypersalivation, and malaise. Four patients (10%) had their doses reduced, seven patients (17.5%) responsive to clobazam although with side effects continued taking the drug as prescribed. The most common side effects of all were hyperactivity and sedation consecutively.
CONCLUSION
Clobazam is an effective treatment for ensuring seizure freedom in pediatric epilepsy, mostly drug-resistant. The side effects are at tolerable levels in patients who are responsive to the drug.
PubMed: 32617066
DOI: 10.14744/SEMB.2020.60252 -
Acute Medicine & Surgery Apr 2017Local anesthetics are commonly used medicines in clinical settings. They are used for pain management during minor interventional treatments, and for postoperative care... (Review)
Review
Local anesthetics are commonly used medicines in clinical settings. They are used for pain management during minor interventional treatments, and for postoperative care after major surgeries. Cocaine is the well-known origin of local anesthetics, and the drug and related derivatives have long history of clinical usage for more than several centuries. Although illegal use of cocaine and its abuse are social problem in some countries, other local anesthetics are safely and effectively used in clinics and hospitals all over the world. However, still this drug category has several side-effects and possibilities of rare but serious complications. Acute neurotoxicity and cardiac toxicity are derived from unexpected high serum concentration. Allergic reactions are observed in some cases, especially following the use of ester structure drugs. Chronic toxicity is provoked when nerve fibers are exposed to local anesthetics at a high concentration for a long duration. Adequate treatments for acute toxic reactions can secure complete recovery of patients, and careful use of drugs prevents long-lasting neurological complications. In addition to respiratory and circulatory management, effectiveness of lipid rescue in the acute toxicity treatment has been certified in many clinical guidelines. Prevention of the use of high concentration of local anesthetics is also validated to be effective to decrease the possibility of nerve fiber damage.
PubMed: 29123854
DOI: 10.1002/ams2.265 -
Journal of Clinical Medicine Jul 2022Purpose: This study aims to assess the satisfaction, compliance, and side effects among the long-term orthokeratology (Ortho-K) users in a tertiary hospital in Taiwan...
Purpose: This study aims to assess the satisfaction, compliance, and side effects among the long-term orthokeratology (Ortho-K) users in a tertiary hospital in Taiwan and analyze the side effects and related risk factors. Methods: Children and their guardians were assessed using a structured and validated questionnaire inquiring about background information, wear and care behaviors, daily activities, satisfaction, and related concerns. Clinical information, including refractive data and side effects, was obtained through patient medical files. Results: Three hundred and five school-aged patients were enrolled, and the average age was 13.13 ± 3.39 years, with an average wearing period of 17.1 ± 8.1 months. Over 83% of the subjects had clear daytime vision all day, around 88% felt satisfied or very satisfied with the results, and 98% exhibited a willingness to continue wearing the Ortho-K lenses. Most guardians (83%) were pleased with the controlling effect of myopic progression. Initial spherical equivalent and regular cleaning of the lens protein significantly correlated with clear day vision. Wearing >6 days/week correlated with less risk of lens binding. Based on the questionnaire, the main reasons for using Ortho-K were effectiveness, safety, and practicality, while the major concerns were discomfort, harmful to the eyes, and no effect. Conclusion: With a comprehensive care program from practitioners and good compliance of users, Ortho-K could be the most effective and satisfactory option for myopic children in Taiwan.
PubMed: 35887890
DOI: 10.3390/jcm11144126 -
Oman Medical Journal Sep 2023In clinical experience, selecting atypical antipsychotics optimally balancing their benefits and potential side effects is seen to improve treatment adherence in...
OBJECTIVES
In clinical experience, selecting atypical antipsychotics optimally balancing their benefits and potential side effects is seen to improve treatment adherence in patients. This study aimed to compare the effectiveness and side effect profiles of aripiprazole and olanzapine in patients with psychotic disorders.
METHODS
In this double-blind clinical trial, the subjects were patients with psychotic disorders treated with aripiprazole and olanzapine. The subjects were randomly divided into two equally sized groups. One group was treated with olanzapine and the other group with aripiprazole. All participants were assessed using the positive and negative syndrome scale and side effects were monitored over a two-month follow-up period.
RESULTS
The participants comprised N = 76 patients (65 male; 11 female). Treatments with both aripiprazole (n = 38) and olanzapine (n = 38) were associated with a significant decrease in the severity of psychotic symptoms over the two-month treatment period. This decrease was achieved faster in the olanzapine group. There were no significant differences in the changes in body mass index, waist circumference, blood sugar, triglyceride, or cholesterol between the two groups. A qualitative difference between the groups was found in their total sleep duration.
CONCLUSIONS
Olanzapine was more effective than aripiprazole in reducing psychotic symptoms. There were no significant differences between the overall side effect profiles of the two drugs.
PubMed: 38249132
DOI: 10.5001/omj.2023.109