Efficacy and safety of glucagon-like peptide 2 in patients with short bowel syndrome: a systematic review and network meta-analysis.

BACKGROUND: Glucagon-like peptide 2 (GLP-2) is a highly conserved enteroendocrine hormone that seems to be a regulator promoting intestinal adaptation. This study aimed to summarize the evidence on the efficacy and safety of exogenous GLP-2 in patients with short bowel syndrome (SBS). METHODS: A database search was performed on PubMed, Web of Science Core Collection, Scopus, Ovid, and the Cochrane Central Register of Controlled Trials in November 2022. Clinical trials on the effect of GLP-2 on patients with SBS were included. The Cochrane Risk of Bias 2 and Risk Of Bias In Non-randomized Studies - of Interventions tools for quality assessment of randomized and nonrandomized trials were used. The extracted data were analyzed qualitatively and quantitatively using a network meta-analysis model. RESULTS: This study included 23 clinical trials with 843 patients. The patients' ages ranged from 4.0 to 62.4 years. The treatment doses were 0.1, 0.05, and 0.025 mg/kg/day for teduglutide; 5 and 10 mg/week for apraglutide, and 0.1, 1, and 10 mg/day for glepaglutide. The treatment duration ranged from 1 to 32 weeks. Regarding citrulline level, 0.1 mg/kg/day of teduglutide had the highest mean difference (MD; 14.77; 95% CI, 10.20-19.33), followed by 0.05 mg/kg/day (13.04; 95% CI, 9.79-16.2) and 0.025 mg/kg/day (7.84; 95% CI, 2.42-13.26) of teduglutide. In addition, the effect estimate showed significant differences between all teduglutide dose groups and the control group. Different doses of glepaglutide were analyzed to assess the effect on alkaline phosphatase (ALP) levels, in which 0.1 mg/day of glepaglutide showed a significantly higher MD (20.71; 95% CI, 2.62-38.80) than 1 mg/day (the reference) and 10 mg/day (8.45; 95% CI, -10.72 to 27.62) of glepaglutide. However, 0.1 vs 10 mg of glepaglutide has an MD of -14.57 (95% CI, -437.24 to 148.11) for the indirect estimate, whereas 10 mg of glepaglutide has an MD of 8.45 (95% CI, -10.72 to 27.62) for the network estimate. Regarding safety outcomes, there was no significant difference among all teduglutide and apraglutide dose groups compared with the control group. Catheter-related bloodstream infection was the most common adverse event reported with the use of apraglutide, teduglutide, and glepaglutide. CONCLUSION: Despite the small number of patients in the included studies and variable follow-up duration, GLP-2 seems to be safe and effective in patients with SBS. GLP-2 showed a positive effect on increasing plasma citrulline level and decreasing ALP level.

Hyperbaric Oxygen and Outcomes Following the Brain Injury: A Systematic Review.

Introduction: Hyperbaric oxygen therapy (HBO2) aims to address ischemia resulting from brain injury by subjecting patients to an atmosphere that dramatically raises the concentration of inspired oxygen (100% O2 at greater than 1 ATA). This results in elevated levels of oxygen in the plasma, which in turn boosts the delivery of oxygen for diffusion to the brain tissue. Objective: To study the efficacy of hyperbaric oxygen (HBO)-based modalities in brain injury. Method: Preferred reporting items for systematic reviews protocol was applied to perform literature search regarding this analytical review. Results: In our study, fifteen studies are included in this review, involving 1067 people. The mean age group of patients enrolled was 57.0±11.6 and the mean NIHSS score was 10.5±8.7, of which 21 participants had moderate to severe neurological impairment. The total number of HBO treatments was 8 to 70 times (28.3±17.9), at the end of the 6-month follow-up period. mRS (modified Rankin scale) ≤3 was found in 25 cases, of which 12 patients with high-grade aSAH recovered. Poor prognosis was prevalent in patients who experienced delayed cerebral ischemia, this was true for 22.7% of patients in this study. In 3 studies conducted by Rockswold, ICP (mm Hg) was significantly lower in the HBO2 group after the treatment than pretreatment. (p<0.05). 4 studies showed an improvement in GCS score after HBO2 therapy.One trial (Imai 2006) reported that three patients in the HBO group died due to pneumonia (two) and heart failure (one) and one patient died in the control group due to heart failure. Overall, it is relatively safe to use HBO in the treatment of brain-related haemorrhage, strokes, and injury as there were no major complications reported. Conclusion: This systematic review demonstrates that HBO2 has significant clinical potential in treatment of brain related haemorrhages, stroke and injury.

Cardioprotective Effects of Nanoparticles in Cardiovascular Diseases: A State-of-the-Art Review.

It has been reported that death related to cardiovascular disease has increased up to 12.5% just in the past decade alone with various factors playing a role. In 2015 alone, it has been estimated that there were 422.7 million cases of CVD with 17.9 million deaths. Various therapies have been discovered to control and treat CVDs and their complications including reperfusion therapies and pharmacological approaches but many patients still progress to heart failure. Due to these proven adverse effects of existing therapies, various novel therapeutic techniques have emerged in the near past. Nano formulation is one of them. It is a practical therapeutic strategy to minimize pharmacological therapy's side effects and nontargeted distribution. Nanomaterials are suitable for treating CVDs due to their small size, which enables them to reach more sites of the heart and arteries. The biological safety, bioavailability, and solubility of the drugs have been increased due to the encapsulation of natural products and their derivatives of drugs.

Afghanistan's humanitarian crisis and its impacts on the mental health of healthcare workers during COVID-19.

Afghanistan's humanitarian crisis has severely impacted the mental health of frontline workers. With the introduction of the Taliban government, ongoing civil unrest, and other forms of violent attacks, healthcare workers (HCWs) continue to provide patient care despite minimal resources. A severe contraction in the economy, poor supply of medications, political turmoil, and insufficient humanitarian aid have added to pre-existing problems. High levels of insecurity and instability as well as decades of traumatic experiences have contributed to increasing mental health challenges amongst frontline workers. Despite the scarcity of mental health services, HCWs continue to persevere with their service to the community. However, inadequate interventions may have serious implications for HCWs bearing the brunt of multiple traumas. Thus, governmental and international involvement is needed to address both the economic and psychological needs of HCWs in Afghanistan.

The future of artificial intelligence in neurosurgery: A narrative review.

Background: Artificial intelligence (AI) and machine learning (ML) algorithms are on the tremendous rise for being incorporated into the field of neurosurgery. AI and ML algorithms are different from other technological advances as giving the capability for the computer to learn, reason, and problem-solving skills that a human inherits. This review summarizes the current use of AI in neurosurgery, the challenges that need to be addressed, and what the future holds. Methods: A literature review was carried out with a focus on the use of AI in the field of neurosurgery and its future implication in neurosurgical research. Results: The online literature on the use of AI in the field of neurosurgery shows the diversity of topics in terms of its current and future implications. The main areas that are being studied are diagnostic, outcomes, and treatment models. Conclusion: Wonders of AI in the field of medicine and neurosurgery hold true, yet there are a lot of challenges that need to be addressed before its implications can be seen in the field of neurosurgery from patient privacy, to access to high-quality data and overreliance on surgeons on AI. The future of AI in neurosurgery is pointed toward a patient-centric approach, managing clinical tasks, and helping in diagnosing and preoperative assessment of the patients.

Water sanitation problem in Pakistan: A review on disease prevalence, strategies for treatment and prevention.

The global water crisis is expected to worsen if urgent action is not taken in making sustainable amends. This applies to Pakistan as the entire country suffers massively from poor water sanitation. Waterborne diseases are rising exponentially attributed to rise in microbial infestations, trace elements and drug toxicity in many water bodies of Pakistan. Treatment and prevention strategies must be implemented through national authorities and at the individual level. Awareness on use of clean water must be emphasized and proper administration on water management policies should be implemented. Immediate and active sustainability for water resources can ensure a safer future for Pakistan.