Impact of Silymarin Supplements on Liver Enzyme Levels: A Systematic Review.

Silymarin, extracted from milk thistle (Silybum marianum), is esteemed for its antioxidative, anti-inflammatory, and antifibrotic properties, notably within liver-related contexts. Nevertheless, a comprehensive grasp of its effects on liver enzymes remains elusive. This systematic review aims to scrutinize the influence of silymarin supplements on liver enzyme levels, elucidating its potential for hepatoprotection. Following PRISMA 2020 guidelines, we systematically reviewed pertinent studies in PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online). Our inclusion criteria comprised randomized clinical trials (RCTs) published between 1992 and 2023, accessible in English, with a primary focus on liver enzyme levels. Non-original research, ambiguously defined studies, and those lacking essential data were excluded. Of the 1,707 initially identified articles, 29 RCTs met the inclusion criteria, encompassing 3,846 participants with diverse underlying conditions. Silymarin dosages ranged from 140 mg to 420 mg, administered for various durations. Results revealed that 65.5% of the studies reported reduced liver enzyme levels, 20.7% exhibited no significant change, and 13.8% observed elevated liver enzymes. The systematic review implies a potential advantageous influence of silymarin on liver enzyme levels, indicating its hepatoprotective potential. Nevertheless, outcome disparities may stem from comorbidities, suboptimal doses, and underlying diseases. Notably, silymarin's impact on liver enzymes could be context-dependent, with varying responses among different conditions, with the decrease of liver enzyme levels in patients with non-alcoholic fatty liver disease. Silymarin supplements exhibit potential for hepatoprotection by ameliorating liver enzyme levels across diverse conditions. Further research should ascertain optimal dosages and contexts, accounting for individual patient characteristics and underlying diseases.

Information Seeking Practices and Availability of Smart Devices Among Healthcare Professionals in a Lower-Middle-Income Country: An Analysis From Pakistan.

Introduction Evidence-based medicine (EBM) is a principle that integrates clinical experience with relevant information available to provide adequate healthcare. It requires access to current medical literature. This paper analyzes the information requirements of a lower-middle-income country (LMIC) and the resources available and preferred by medical professionals. Methods A survey-based cross-sectional study was carried out among 160 participants, ranging in expertise from students to attending physicians in Karachi, Pakistan. The survey comprised questions to assess the clinical background, technology access, need for health-related information, and the preference for resources to obtain that information in different scenarios. They were also asked if they use PubMed and their recommended methods to improve information access. Statistical Package for the Social Sciences (SPSS; IBM, NY, USA) software was used for all analyses. Results A basic mobile phone (with limited internet connectivity) was the most common device used at home (n=159; 99.4%) and work (n=141; 88.1%). No smart devices were available to 28 (17.5%) participants at work. Internet connectivity was available for 155 (96.9%) participants at home but only for 118 (73.7%) participants at work. About one-third (n=49; 30.6%) experienced questions arising in practice two to four times a day, and half of the participants (n=80; 50%) were very likely to look up a reference. The most common resource for the majority of given clinical scenarios was a senior colleague. At the same time, medical websites (Medscape, Up-to-Date, WebMD) were the first choice for a non-specific general medical query. About 68.75% (n=110) of participants claimed to use PubMed in daily practice. The most common reason for not using PubMed was the ease of using other search engines (like Google). Conclusions Improved access to the internet and well-reputed journals can enhance the practice of EBM in Pakistan. Limitations of technological access must be considered while designing information resources in lower-middle-income countries.

Canagliflozin and Cardiovascular disease- results of the CANVAS trial.

Canagliflozin is a new novel oral antidiabetic agent belonging to the class of sodium-glucose co-transporter 2 (SGLT2) inhibitors, inhibiting glucose reabsorption in the proximal tubule, leading to increased urinary glucose excretion and subsequently to reduction in plasma glucose concentration, in individuals with hyperglycemia. Before the approval of canagliflozin by the Food and Drug Administration (FDA) in 2013, a pair-wise meta-analyses of trials involving canagliflozin did not differ from control in terms of all-cause mortality, cardiovascular death, myocardial infarction, and stroke. However, no large, randomized-controlled trials were available for comparison until the results of the CANVAS (Canagliflozin Cardiovascular Assessment Study) trial were published. The CANVAS Trial was designed to assess the cardiovascular safety and efficacy of canagliflozin. Recently, results of the completed CANVAS Trial were released which showed patients with type 2 diabetes and established cardiovascular disease or at high risk for cardiovascular events who were treated with canagliflozin had significantly lower rates of the primary cardiovascular outcome than patients assigned to placebo. All three components of the primary outcome - death from cardiovascular causes, nonfatal myocardial infarction, and nonfatal stroke - showed point estimates of effect that suggested benefit .These results may represent a significant additional therapeutic tool in the clinical prevention and management of cardiovascular mortality and morbidity. However, data on the long-term efficacy on the use of Canagliflozin is still incomplete and their use in patients with type 2 diabetes should be carefully considered.

Topical vasodilator response in skeletonized internal mammary artery: Is there really a difference?

AIM OF THE STUDY: Coronary artery bypass graft surgery is the gold standard for the treatment of multivessel and left main coronary artery disease. However, there is considerable debate that whether left internal mammary artery (IMA) should be taken as pedicled or skeletonized. This study was conducted to assess the difference in blood flow after the application of topical vasodilator in skeletonized and pedicled IMA. MATERIALS AND METHODS: In this study, each patient underwent either skeletonized (n = 25) or pedicled IMA harvesting (n = 25). The type of graft on each individual patient was decided randomly. Intraoperative variables such as conduit length and blood flow were measured by the surgeon himself. The length of the grafted IMA was carefully determined in vivo, with the proximal and distal ends attached, from the first rib to IMA divergence. The IMA flow was measured on two separate occasions, before and after application of topical vasodilator. Known cases of subclavian artery stenosis and previous sternal radiation were excluded from the study. RESULTS: The blood flow before the application of topical vasodilator was similar in both the groups (P = 0.227). However, the flow was significantly less in pedicled than skeletonized IMA after application of vasodilator (P < 0.0001). Similarly, the length of skeletonized graft was significantly higher than the length of pedicled graft (P < 0.0001). CONCLUSION: Our study signifies that skeletonization of IMA results in increased graft length and blood flow after the application of topical vasodilator. However, we recommend that long-term clinical trials should be conducted to fully determine long-term patency rates of skeletonized IMA.