Mechanisms of vascular injury in neurotrauma: A critical review of the literature

One in every two individuals will experience a traumatic brain injury in their lifetime with significant impacts on the global economy and healthcare system each year. Neurovascular injury is a key aspect of neurotrauma to both the brain and the spinal cord and an important avenue of current and future research seeking innovative therapies. In this paper, we discuss primary and secondary neurotrauma, mechanisms of injury, the glymphatic system, repair and recovery. Each of these topics are directly connected to the vasculature of the central nervous system, affecting severity of injury and recovery. Consequently, neurovascular injury in trauma represents a promising target for future therapeutics and innovation.

Efficacy of therapeutic ultrasound vs sham ultrasound on pain and physical function in people with knee osteoarthritis: A meta-analysis of randomized controlled trials

AIM: To determine the efficacy of therapeutic ultrasound vs sham for improving pain and physical function immediately post-intervention in people with knee osteoarthritis (OA).

METHODS: We hand searched meta-analyses on the topic published in 2010 and updated the search in three electronic databases (MEDLINE, EMBASE, CINAHL) January 1, 2009 to September 5, 2013 to identify relevant studies. The inclusion criteria were human randomized controlled trials published in the English language in which active therapeutic ultrasound was compared to sham ultrasound, data for people with knee OA were reported separately, participants were blinded to treatment allocation and outcomes assessed before and after treatment included pain, self-reported physical function and performance-based physical function. Two reviewers independently screened titles and abstracts retrieved in the search to identify trials suitable for full text review. Data extraction and risk of bias assessment of the identified trials were completed independently by two reviewers. Pooled analyses were conducted using inverse-variance random effects models.

RESULTS: We screened 1013 titles and abstracts. Meta-analysis of pain outcomes from 5 small trials (281 participants/OA knees) showed that, compared to sham ultrasound, therapeutic ultrasound improves pain [standardized mean difference (SMD) (95%CI) = -0.39 (-0.70, -0.08); P = 0.01] but not physical function [self-reported in 3 trials (130 participants/OA knees): SMD (95%CI) = -0.21 (-0.55, 0.14), P = 0.24; walking performance in 4 trials (130 participants/OA knees): SMD (95%CI) = -0.11 (-0.59, 0.37), P = 0.65). For the walking performance outcome, the dispersion of the estimated effects exceeded that expected due to sampling error (χ² = 8.37, P = 0.04, I² = 64%). Subgroup analyses of three trials that administered high dose ultrasound improved the consistency (I² = 28%) but the treatment effect remained insignificant.

CONCLUSION: Meta-analyzed double-blind placebo-controlled randomized trials provide low-strength evidence that therapeutic ultrasound decreases knee OA pain and very low-strength evidence that it does not improve physical function.

Efficacy of bright light therapy for perinatal depression: A meta-analysis of a randomized controlled trial

BACKGROUND

Pharmacological treatments are commonly used in individuals experiencing perinatal depression (PPD); however, a debate regarding the reproductive safety of antidepressants is ongoing. Many pregnant women opt to discontinue antidepressant out of concern about potential negative effects on the developing fetus, while slow and ineffective antidepressant medications hinder improved outcomes in women with PPD. In recent years, bright light therapy (BLT) has gained traction as a treatment option for PPD; however, clinical trials findings examining the efficacy of BLT in this population have been inconclusive.

AIM

To validate the feasibility and safety of BLT for the treatment of PPD.

METHODS

We performed a meta-analysis of randomized controlled trials of patients with PPD treated with BLT vs placebo following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. We searched PubMed, Embase, the Cochrane Library, and Web of Science for randomized controlled studies published up to December 2023. The results were evaluated using the standardized mean difference of improvement for depression scores and odds ratios (ORs) for remission rate, response rate, incidence of adverse events, and dropout rate.

RESULTS

The BLT group had higher PPD response rate [50.68% vs 33.08%; OR = 2.05; 95% confidence interval (CI): 1.25-3.35; P = 0.004; I^² = 35%] and remission rate (54.10% vs 18.52%; OR = 5.00; 95%CI: 2.09-11.99; P = 0.0003; I^² = 0%) than the placebo group. Improvements in depression scores were higher in the BLT group than the placebo group for the overall efficacy (standardized mean difference = -0.47; 95%CI: -0.80 to -0.13; P = 0.007). No significant differences between the two groups in drop-outs (21.84% vs 29.63%; OR = 0.63; 95%CI: 0.31-1.29; P = 0.21; I^² = 0%) or adverse events (17.89% vs 9.68%; OR = 2.01; 95%CI: 0.95-4.25; P = 0.07; I^² = 0%) were observed.

CONCLUSION

BLT can potentially treat PPD, showing better results than the control group in this study. BLT is effective and safe and could increase the available therapeutic options for PPD.

Gender prevalence of cardiovascular diseases in the geriatric population of India: A meta-analysis using R

BACKGROUND

Population ageing is an important challenge for developed as well as developing countries due to the downward trends in mortality rates. The elderly population is increasing worldwide. Cardiovascular diseases (CVDs) are one of the most common diseases in the geriatric population. These diseases involve the heart or blood vessels and include hypertension, rheumatic heart disease, heart failure, and heart attack. An estimated 17.7 million people in India will die from CVDs representing 31% of all global deaths.

AIM

To perform a systematic review and meta-analysis of the gender prevalence of CVDs in the geriatric population of India.

METHODS

In the present study, we searched databases such as Google Scholar, PubMed and MEDLINE from the year 2003 to 2019 to identify the prevalence of CVDs in the Indian geriatric population. A meta-analysis was conducted using the statistical software R version 3.4.3 and the random effect model was used to determine the pooled estimate of the prevalence of CVDs in the geriatric population of India along with the 95% confidence interval rather than using the fixed effect model. The random effect model takes into consideration the heterogeneity across the various studies.

RESULTS

The prevalence of CVDs in the Indian geriatric population was determined in 6586 male subjects from 32 studies and 8164 female subjects from 32 studies, respectively. The overall prevalence of CVDs in the Indian geriatric population was 36.6% (95%CI: 31.9%-41.3%). In addition, calculation of the various heterogeneity statistics (Cochran’s Q = 3836.85, I² = 98.6%, P < 0.0001) indicated heterogeneity in the prevalence of CVDs in the elderly Indian population in these studies. The prevalence of CVDs in elderly males was 38.0% (95%CI: 33.0%-43.0%) and the prevalence of CVDs in elderly females was 40.9% (95%CI: 35.5%-46.2%).

CONCLUSION

The results indicate that the prevalence of CVDs in the female geriatric population was relatively higher than that in the male geriatric population. Policy makers must take immediate steps to prevent CVDs and improve geriatric health care services in India.

Asymptomatic bacteriuria among hospitalized diabetic patients: Should they be treated?

Diabetes Mellitus is a significant health care challenge in the United States. The Center for Disease Control and Prevention estimates approximately 9.4% of patients in the United States are afflicted by diabetes. The Infectious Disease Society of America asymptomatic bacteriuria in women as two consecutive clean-catch voided urine specimens with isolation of the same bacterial strain in counts ≥ 10⁵ cfu/mL It is understood that diabetic patients tend to be at higher risk for infections than non-diabetics. Urinary tract infections (UTIs) tend to be the most common infection contracted by this population. UTIs are not only a significant cause of morbidity and mortality, they are also a significant financial burden. The data are conflicting, in regard to treating asymptomatic bacteriuria in diabetic patients to avoid hospital complications and ultimately decrease healthcare costs associated with these complications. However, clinicians continue to prescribe antibiotics empirically. Further randomized controlled study looking into the specific population as immunocompromised diabetic patients, patient with diabetic ketoacidosis and patient in intensive care unit needs to be undertaken.

Incidence of luminal gastrointestinal cancers in patients with cirrhosis: A systematic review and meta-analysis

BACKGROUND

The global incidence of cirrhosis and luminal gastrointestinal cancers are increasing. It is unknown if cirrhosis itself is a predisposing factor for luminal gastrointestinal cancer. Such an association would have significant clinical implications, particularly for cancer screening prior to liver transplantation.

AIM

To investigate the incidence of luminal gastrointestinal cancers in patients with underlying cirrhosis.

METHODS

An electronic search was conducted to study the incidence of luminal gastrointestinal cancers in patients with cirrhosis. Study-specific standardized incidence ratios (SIR) along with corresponding 95%CI for both overall cancer incidence and luminal cancer incidence were analyzed using a random-effects model. Subgroup analysis was performed based on cirrhosis etiology and location of luminal malignancy.

RESULTS

We identified 5054 articles; 4 studies were selected for data extraction. The overall incidence of all cancers was significantly higher in patients with cirrhosis, with an SIR of 2.79 (95%CI: 2.18–3.57). When stratified by cirrhosis etiology, the incidence of luminal cancers remained significantly elevated for alcohol (SIR = 3.13, 95%CI: 2.24–4.39), Primary Biliary Cholangitis (SIR = 1.40, 95%CI: 1.10–1.79), and unspecified cirrhosis (SIR = 3.52, 95%CI: 1.87–6.65).

CONCLUSION

The incidence of luminal gastrointestinal cancer is increased amongst patients with cirrhosis. Oral cavity, pharyngeal and esophageal cancer had increased incidence across all cirrhosis etiologies compared to gastric and colorectal cancer. Therefore, increased screening of luminal cancers, and in particular these upper luminal tract subtypes, should be considered in this population.

Diabetes distress, the mediator of the poor glycemic control and depression: A meta-analysis

BACKGROUND

Diabetes-related distress (DRD) is a common psychological disorder specifically associated with diabetes, its cross-talk with depression, and glycated hemoglobin (HbA1c) was discussed controversially. Interventions addressing DRD were shown to improve HbA1c. However, the primary concern is to investigate the association of DRD with glycemic control. No meta-analyses have compared the effects of depression and diabetes distress on HbA1c.

AIM

To assess the relationship between DRD, depression, and glycemic control.

METHODS

We systematically searched PubMed MEDLINE, Google Scholar, and Cochrane Library from inception up to May 2024. The keywords diabetes distress, depression, psychopathology, glycemic control, HbA1c, glycated hemoglobin, fasting, and postprandial blood glucose were used. A datasheet was used to extract the author’s name year and country of publication, diabetes distress, depression, and HbA1c among patients with DRD, depression, and control subjects.

RESULTS

Out of the 2046 studies retrieved, 55 full texts were screened and 22 studies were included in the final meta-analysis. Diabetes distress was associated with poor glycemic control, odd ratio = 0.42, 95% confidence interval (CI): 0.17-0.67, and P value < 0.001, and odd ratio = 0.52, 95%CI: 0.38-0.72, and P value < 0.001 respectively. No significant difference was observed between depression and DRD regarding the impact on HbA1c, odd ratio = 0.13, 95%CI: 0.15-0.41, P value = 0.37, I² for heterogeneity = 76%. However, when heterogeneity was eliminated, diabetes distress influenced the HbA1c more compared to depression, odd ratio = 0.29, 95%CI: 0.17-0.41, and P value < 0.001.

CONCLUSION

DRD negatively influenced the HbA1c and glycemic control more than depression. Further studies using more specific measures (ecological momentary assessment) to assess DRD are recommended.

Utility of gastrointestinal ultrasound in functional gastrointestinal disorders: A narrative review

Gastrointestinal (GI) ultrasound (GIUS) is valuable in the evaluation of GI diseases such as inflammatory bowel disease, but its use in functional GI disorders (FGIDs) is largely unknown although promising. In order to review the current knowledge on current and potential uses of GIUS in FGIDs, information was obtained via a structured literature search through PubMed, EMBASE and Google Scholar databases with a combination of MESH and keyword search terms: “ultrasound”, “functional GI disorders”, “irritable bowel syndrome”, “functional dyspepsia”, “intestinal ultrasound”, “point of care ultrasonography”, “transabdominal sonography”, “motility”, “faecal loading”, “constipation”. GIUS is currently used for various settings involving upper and lower GI tracts, including excluding organic diseases, evaluating physiology, guiding treatment options and building rapport with patients. GIUS can be potentially used to correlate mechanisms with symptoms, evaluate mechanisms behind treatment efficacy, and investigate further the origin of symptoms in real-time. In conclusion, GIUS is unique in its real-time, interactive and non-invasive nature, with the ability of evaluating several physiological mechanisms with one test, thus making it attractive in the evaluation and management of FGIDs. However, there are still limitations and concerns of operator dependence and lack of validation data for widespread implementation of GIUS in FGIDs.

Sirturo (Bedaquiline): The first new anti tubercular drug in decades

Tuberculosis (TB) is an infection caused by Mycobacterium tuberculosis and is one of the world’s deadliest diseases. Multidrug resistant TB (MDR-TB) is a serious form of TB and it implies resistance for at least two essential first-line agents like, Isoniazid and Rifampicin. The US Food and Drug Administration (FDA) granted accelerated approval to Janseen Therapeutics “Sirturo (Bedaquiline)”, a diarylquinoline anti mycobacterial drug on December 28, 2012 as part of combination therapy in adults (≥ 18 years) to treat MDR-TB when other alternatives are not available. The FDA also granted Sirturo fast track designation, priority review and orphan-product designation. Bedaquiline inhibits mycobacterial ATP (adenosine 5’-triphosphate) synthase, an enzyme that is essential for the generation of energy in Mycobacterium tuberculosis.

Role of long non-coding RNAs in non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is emerging as a common cause of chronic liver disease in children and adults. NAFLD can progress to steatohepatitis and potentially even hepatocellular carcinoma. Early identification of patients at risk for progressive disease is crucial for managing NAFLD. Recent studies have identified long noncoding RNAs (lncRNAs), circular RNAs, and microRNAs as playing important roles in the pathogenesis of NAFLD. These noncoding RNAs are involved in modulating several metabolic pathways such as hepatic glucose and lipid metabolism, oxidative stress, and even carcinogenesis. Elevated levels of lncARSR and lncRNA nuclear-enriched abundant transcript 1 have been found in patients with NAFLD. In addition, lncRNAs such as PRYP4-3 and RP11-128N14.5 can distinguish patients with NAFLD from healthy individuals. Increased MEG3 expression has been observed in both NAFLD and non-alcoholic steatohepatitis, suggesting that it may help predict patients at risk for disease progression. With advances in transcriptomics, we may discover additional targets to help in the identification and prognostication of NAFLD.

Fibroblast activation protein inhibitors positron emission tomography/computed tomography: Review of the literature

Positron emission tomography/computed tomography (PET/CT) with radiolabeled fibroblast activation protein inhibitors (FAPI) is an increasingly relevant molecular diagnostic image in oncology given the high expression of FAP in cancer associated fibroblast, being present in almost 90% of the epithelial carcinomas, which allows imaging with excellent diagnostic performance and can also become a therapeutic strategy. This review summarizes the literature on FAPI-PET/CT for the cancer evaluation and compares it in some scenarios with the ¹⁸F-Fluorodeoxyglucose PET/CT.

Surgery with adjuvant or neoadjuvant treatment vs surgery alone for resectable pancreatic cancer: A network meta-analysis

BACKGROUND

Pancreatic cancer is one of the most common and lethal malignancies worldwide. The common treatment options for resectable pancreatic cancer include surgery alone, neoadjuvant chemotherapy (CT), neoadjuvant chemoradiotherapy (CRT), adjuvant CT, and adjuvant CRT. However, the optimal treatment is still controversial.

AIM

To identify the most effective approach for pancreatic cancer using network meta-analysis.

METHODS

Eligible studies were searched from PubMed, MEDLINE, EMBASE, Cochrane database, and Google scholar. We searched and included randomized controlled trials reporting on neoadjuvant and adjuvant therapies. For direct comparisons, standard pairwise meta-analysis was performed using the inverse variance DerSimonian-Laird random-effects model. For indirect comparisons, Bayesian network meta-analysis was used to combine direct and indirect evidence. We used relative hazard ratios (HRs) to estimate death difference of different treatments, and relative odds ratios (ORs) for toxic effects. Treatment effects were ranked based on their efficacy for improving survival or reducing toxicity using rankogram. The quality of evidence of estimates from direct comparison and network meta-analysis was evaluated following the GRADE approach.

RESULTS

We included 13 high quality trials with 1591 participants in this network meta-analysis. Compared with surgery alone [pooled HR = 0.7, 95% confidence interval (CI): 0.62-0.79] and surgery with adjuvant CRT (pooled HR = 0.6, 95%CI: 0.54-0.72), surgery with adjuvant CT had a higher rate of overall survival. In contrast, standard pairwise meta-analysis showed a statistically significant survival advantage of surgery with adjuvant CT compared with surgery alone (pooled HR = 0.75, 95%CI: 0.63-0.89; P < 0.001). Rankogram showed that surgery with adjuvant CT was most likely to rank the best in terms of overall survival (probability: 94.2%), followed by surgery alone (probability: 5.8%). No significant differences in overall toxicity or haematological toxicity were found between all the therapies. High quality evidence supported surgery with adjuvant CT over surgery alone for increasing overall survival. Moderate quality evidence supported surgery with adjuvant CT over surgery with adjuvant CRT for increasing overall survival.

CONCLUSION

Surgery with adjuvant CT prolongs overall survival compared with surgery alone and surgery with adjuvant CRT, suggesting surgery with adjuvant CT is the optimal treatment for resectable pancreatic cancer.

Effectiveness of Pilates exercises in sports

Participation in sports is spreading all around the world in an attempt of the community to stay active, healthy, prevent health issues and conditions and to ensure quality of life while there is life expectancy and population is getting more and more older. Existing protocols in rehabilitation are sometimes demanding and are addressed in athletes and people with good physical condition while population gets involved in recreational sports activities more and more. Sport injuries are very common not only in athletes but in general population as well. Pilates is a very popular type of exercise and industry around it is flourishing. Although there are indications that it could be used as an alternative in rehabilitation, research is limited in certain fields. The aim of this editorial is to motivate researchers to conduct well-designed studies in sports injuries’ rehabilitation based on the Pilates method, to explore the efficacy of the method as a complementary approach and the optimal integration strategies in diverse sports rehabilitation settings. Last but not least, it is an attempt for the need of the community to establish certification on Clinical Pilates Physiotherapists based on the principles of rehabilitation.

History, origin, transmission, genome structure, replication, epidemiology, pathogenesis, clinical features, diagnosis, and treatment of COVID-19: A review

In December, 2019, pneumonia triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) surfaced in Wuhan, China. An acute respiratory illness named coronavirus disease 2019 (COVID-19) is caused by a new coronavirus designated as SARS-CoV-2. COVID-19 has surfaced as a major pandemic in the 21st century as yet. The entire world has been affected by this virus. World Health Organization proclaimed COVID-19 pandemic as a public health emergency of international concern on January 30, 2020. SARS-CoV-2 shares the same genome as coronavirus seen in bats. Therefore, bats might be its natural host of this virus. It primarily disseminates by means of the respiratory passage. Evidence revealed human-to-human transmission. Fever, cough, tiredness, and gastrointestinal illness are the manifestations in COVID-19-infected persons. Senior citizens are more vulnerable to infections which can lead to dangerous consequences. Various treatment strategies including antiviral therapies are accessible for the handling of this disease. In this review, we organized the most recent findings on COVID-19 history, origin, transmission, genome structure, replication, epidemiology, pathogenesis, clinical features, diagnosis, and treatment strategies.

Treatment of recurrent hepatocellular carcinoma following liver resection, ablation or liver transplantation

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and causes one third of cancer related deaths world-wide. Approximately one third of patients with HCC are eligible for curative treatments that include hepatic resection, liver transplantation or imaging guided tumor ablation. Recurrence rates after primary therapy depends on tumor biology and pre-treatment tumor burden with early recurrence rates ranging from 30%-80% following surgical resection and ablation. HCC recurs in over ten percent following liver transplantation for HCC. Treatment modalities for tumor recurrence following resection and ablation include repeat liver resection, salvage liver transplantation, locoregional therapies, and systemic chemotherapy/immunotherapy. Locoregional and immune mediated therapies are limited for patients with tumor recurrence following liver transplantation given potential immune related allograft rejection. Given the high HCC recurrence rates after primary tumor treatment, it is imperative for the clinician to review the appropriate treatment strategy for this disease entity. This article will review the current literature regarding HCC recurrence after primary curative therapies and will discuss the relevant future trends in the HCC field.

Nutritional interventions in the treatment of Hashimoto’s disease: A systematic review

BACKGROUND

Hashimoto’s thyroiditis (HT) is an autoimmune dysfunction caused by genetic and environmental changes that attack the thyroid gland. HT affects approximately 2% to 5% of the population, being more prevalent in women. It is diagnosed through a blood test (anti-thyroid peroxidase). Pharmacological treatment consists of daily administration of the synthetic hormone levothyroxine on an empty stomach. The most common signs and symptoms are: Tissue resistance to triiodothyronine T3, weight gain, dry skin, hair loss, tiredness/fatigue, and constipation, and nutritional therapy appears to help reduce these symptoms.

AIM

To analyze nutritional interventions for treating HT.

METHODS

This is an integrative review of original studies on nutritional interventions for treating Hashimoto’s disease. Articles were searched in the MEDLINE/PubMed and Latin American and Caribbean Literature on Health Sciences (LILACS) databases via virtual health library, using controlled vocabulary and free terms. A total of 70 articles were found: 67 from PubMed and 3 from LILACS. After exclusions, 9 articles met the eligibility criteria, including dietary interventions for maintaining and restoring the patient’s quality of life.

RESULTS

The reviewed articles evaluated the nutritional treatment of HT through supplementation of deficient micronutrients, anti-inflammatory diets, gluten-free diets, exclusion of foods that cause food sensitivities, lactose-free diet, paleo diet, and calorie restriction diets. However, some results were controversial regarding the beneficial effects of HT.

CONCLUSION

In general, it was observed that nutritional interventions for HT are based on the recovery of micronutrient deficiencies, treatment of the intestinal microbiota, diet rich in foods with anti-inflammatory properties, lifestyle changes, and encouragement of healthy habits.