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Nephrotoxicity is one of the most important complications in cancer patients under treatment with cisplatin-containing regimens. Curcumin, as the most important active component of Curcuma longa, is an antioxidant and anti-inflammatory compound. In this clinical trial, we assessed the preventive effect of nano-curcumin oral formulation against cisplatin-induced nephrotoxicity in cancer patients. In this triple-blind clinical trial 30 cancer patients on cisplatin were randomly included in the treatment group, receiving nano-curcumin 40â mg capsules (nâ =â 15) or the placebo group (nâ =â 15) twice a day during four chemotherapy courses. Kidney function was measured at the beginning of the study and then at the end of each course of chemotherapy. There was no significant difference in acute kidney injury occurrence rate and creatinine and blood urine nitrogen serum levels between the treatment and placebo groups at the end of each chemotherapy course (P value >0.05). Just at the end of the first course, the difference was close to significant (Pâ =â 0.055). We also found no difference in mortality and recurrence rate in an average 30-month follow-up. Nano-curcumin in the prescribed dose and duration was not effective in preventing cisplatin-induced nephrotoxicity in cancer patients in comparison with the placebo. Further studies with larger sample size using different doses and duration of nano-curcumin are recommended.
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Radiodermatitis in breast cancer patients varies from mild irritation to life-threatening lesions. Several studies suggest a role for topical corticosteroid ointments in the treatment of radiodermatitis. Yet, to avoid the adverse effects of corticosteroids, many authors recommend the use of topical herbal products instead. The therapeutic role of herbal treatments has yet to be fully understood. This systematic review evaluates the role of topical or oral herbal medicines in radiodermatitis prevention and treatment. A systematic search of four databases (Embase, PubMed, Web of Science, and Scopus) was performed without language and time restrictions from their inception until April 2023. The bibliographies of potential articles were also searched manually. Studies evaluated and compared the effects of herbal preparations with the control group, on dermatitis induced by radiotherapy for breast cancer. The Cochrane risk of bias tool was used to assess the included studies. Thirty-five studies were included in the systematic review. Studies which used herbal drugs including topical and oral formulations were evaluated. Herbal monotherapy and combination therapy were reported, and their effects on radiodermatitis were explained in the systematic review. In conclusion, henna ointments, silymarin gel, and Juango cream were reported to reduce the severity of radiodermatitis. These agents should be considered for radiodermatitis prophylaxis and treatment. The data on aloe gel and calendula ointment were conflicting. Further randomized controlled trials of herbal medications and new herbal formulations are required to determine their effects on breast cancer radiodermatitis.
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Neoplasias da Mama , Radiodermite , Silimarina , Humanos , Feminino , Radiodermite/tratamento farmacológico , Radiodermite/prevenção & controle , Pomadas/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/radioterapia , Extratos Vegetais , Silimarina/uso terapêuticoRESUMO
Breast cancer is one of the most prevalent malignancies among women around the world. RAS proteins require posttranslational modifications, including protein prenylation for proper membrane localization and signaling. Regulation of RAS signaling via specific and novel pharmacological inhibitors is a potentially novel therapeutic approach in breast cancer therapy. This review summarizes the recent knowledge about the clinical value of RAS prenylation pharmacological inhibitors in breast cancer treatment.
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BACKGROUND: While new studies are being published on the prehospital continuous positive airway pressure (CPAP) application in patients with respiratory failure with conflicting results, previous meta-analyses are showing the benefits of CPAP in the prehospital transfer of patients with respiratory distress. Before the clinical application of high-level evidence, updated pooled estimates are needed based on the growing literature. This study aimed to compare prehospital CPAP with the usual standard oxygen therapy of respiratory failure patients. MATERIALS AND METHODS: PRISMA guidelines served as the framework for this updated review study. It is an extension of a prior systematic review. We conducted comprehensive searches across several databases, including PubMed, Web of Science, Embase, and Scopus, focusing on randomized trials that juxtaposed pre-hospital CPAP application against standard care. Our primary interest was to assess the in-hospital mortality risks, and we employed random effect models to aggregate risk ratios from the selected studies. RESULTS: Four articles were gathered based on the review of the updated literature (2013 to November 2022) in conjunction with the research incorporated in the preceding meta-analysis with a total number of 747 patients receiving prehospital CPAP with 101 events of in-hospital mortality. In the standard treatment control groups, there were 713 patients and 115 deaths occurred. Pooled mortality risk comparison between the group of prehospital CPAP and standard care patients had no statistically significant difference (P=0.16). There was no heterogenicity. A regression between the year of the studies and the effect size showed increased RR in new studies (P=0.017). CONCLUSION: Still more randomized trials are needed with higher sample sizes to conclude the lifesaving efficacy of the out-of-hospital CPAP.
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Vitiligo is a recalcitrant depigmentary autoimmune skin disorder. Hydroxychloroquine (HCQ) is an effective immunomodulatory drug which is widely used in treatment of autoimmune disorders. HCQ-induced pigmentation has been previously found in patients taking HCQ due to other autoimmune diseases. The present study aimed to determine whether HCQ improves re-pigmentation of generalized vitiligo. HCQ was orally administered 400 mg daily (6.5 mg/Kg of body weight) by 15 patients with generalized vitiligo (more than 10% involvement of body surface area) for three months. Patients were evaluated monthly and skin re-pigmentation was assessed using the Vitiligo Area Scoring Index (VASI). Laboratory data were obtained and repeated monthly. Fifteen patients (12 women and 3 men) with a mean age of 30.13±12.75 years were studied. After 3 months, the extent of re-pigmentation on all the body regions, including the upper extremities, hands, trunk, lower extremities, feet, and head and neck was significantly higher than the baseline (P value <0.001, 0.016, 0.029, <0.001, 0.006, 0.006, respectively). Patients with concomitant autoimmune diseases had significantly more re-pigmentation compared with others (P=0.020). No irregular laboratory data were observed during the study. HCQ could be an effective treatment for generalized vitiligo. The benefits are likely to be more evident in case of concomitant autoimmune disease. The authors recommend additional large-scale controlled studies to draw further conclusions.
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Doenças Autoimunes , Vitiligo , Masculino , Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Hidroxicloroquina/uso terapêutico , Resultado do TratamentoRESUMO
PURPOSE: To systematically review the recent alternative medical interventions on renal colic pain and compare their efficiency with conventional treatments. MATERIALS AND METHODS: This was a systematic review and network meta-analysis (NMA) study, based on the PRISMA guidelines on online databases of PubMed, Scopus, and web of science. We quarried these databases with relevant keywords for clinical trial studies that aimed at reducing renal colic pain in patients refereeing to the ED from after January 2011 to February 2022. Randomized clinical trials that used the Visual Analogue Scale (VAS) for assessment of renal colic pain before and after medical interventions in adult patients were included in this study. NMA was conducted based on the continuous values of the mean difference of the pain after 30 and 60 minutes of the medication administration. RESULTS: Twenty-four studies that were meeting the inclusion criteria were included in our review with 2724 adult participants who were mostly male. Study arms included conventional medications (NSAID, Opioid, paracetamol), ketamine, MgSo4, desmopressin, and lidocaine. Based on the qualitative synthesis, ten studies (41.7%) did not find significant differences between conventional and alternative treatments. Also, there is no agreement on some more recent medications like using ketamine or desmopressin while MgSO4 and lidocaine use are supported by most studies. NMA revealed that desmopressin is significantly having worse pain reduction properties. NMA did not show any difference between ketamine, lidocaine, and MgSo4, versus the conventional treatment. CONCLUSION: To conclude, lidocaine and MgSo4 might be good alternative treatments for renal colic when conventional treatments are contraindicated or pain is not responding to those. Ketamine might be indicated in patient-based circumstances. Desmopressin may be agreeably avoided in further research or clinics.
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Cólica Renal , Humanos , Masculino , Feminino , Cólica Renal/tratamento farmacológico , Cólica Renal/etiologia , Metanálise em Rede , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Introduction: Point-of-Care Testing (POCT) could be helpful in clinical decisions, treatment selection, monitoring, prognostication, operational decision-making, and resource utilization. This study aimed to review the role of POCT in time metrics of performing urgent interventions in the emergency department (ED) or disposition time to proper care. Methods: This was a systematic review of the literature based on the PRISMA statement. PubMed, Scopus, Web of Science, and EMBASE databases were searched for studies reporting the application of the POCT in the ED with outcomes of the time to intervention or disposition. Results: After reviewing 3708 articles, 16 studies with 100,224 participants were included in this systematic review. There were 5 randomized clinical trials (RCTs), 5 retrospective cohorts, 2 prospective cohorts, and 4 before-after studies. All studies were performed in an ED setting except for one study of prehospital EMS air medical transport. Different panels, ultrasound, cardiac parameters, echocardiography, and polymerase chain reaction (PCR) POCTs were used in the studies. Regarding the outcome measures, studies with many types of patients referring to ED used different indices of time to intervention or time to disposition. Studies on different shock circumstances used the time to the first bolus of hydration or vasopressor or intravenous antibiotics for septic shock patients and central venous catheterization (CVC) placement time in one study. Time to imaging was considered as the outcome in some studies. Overall, there was a high risk of bias, especially in case of the randomization methods, and non-blinded designs in RCTs. There was lower possibility of bias in non-randomized studies but the studies did not have enough follow-ups and in case of studies using advanced panels of POCT, results do not seem to be easily applicable to public health care in many countries. Conclusion: In synthesis of the evidence, all included studies were reporting the benefits of the POCT in decreasing the time to proper interventions and increasing the time to negative interventions in the last lines of critical care as well as the intubation and CVC placement.
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INTRODUCTION: Chloroquine (CQ) and hydroxychloroquine (HCQ) originally were prescribed for prevention or treatment of malaria, but now successfully are used in several rheumatologic diseases. In addition, in recent decades considering their immunomodulatory effects, high tolerably, and low cost, they are evaluated for various viral infections from HIV to COVID-19. AREAS COVERED: In this review, we tried to summarize all available studies on HCQ and CQ efficacy for management of viral infections and the probable mechanisms of action. The data were collected by searching 'Hydroxychloroquine,' 'Chloroquine,' 'Viral infection,' and names of various viral infections in PubMed/MEDLINE, Scopus, and Google Scholar databases from commencement to June 2020. Out of 95 search results, 74 most relevant works were gathered. EXPERT OPINION: HCQ/CQ showed acceptable efficacy in HIV especially as an adjuvant treatment beside routine HAART. However, for some viral infections such as ZIKA, EBOLA, SARS-CoV, and MERS-CoV, human studies are lacking. In the COVID-19 pandemic, in vitro and preliminary human studies showed encouraging findings. However, later well-designed trials and retrospective studies with large sample size not only reported non-significant efficacy but also showed more cardiac adverse reactions. Alkalinization of acid vesicles is the most important mechanism of action.
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Antimaláricos/farmacologia , Antivirais/farmacologia , Cloroquina/farmacologia , Infecções por Coronavirus/tratamento farmacológico , Reposicionamento de Medicamentos , Infecções por HIV/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Antimaláricos/uso terapêutico , Antivirais/uso terapêutico , Betacoronavirus , COVID-19 , Cloroquina/uso terapêutico , HIV-1 , Humanos , Hidroxicloroquina/farmacologia , Hidroxicloroquina/uso terapêutico , Pandemias , SARS-CoV-2RESUMO
Some studies showed that children have a lower response to systemic use of pentavalent antimoniate than adults. We aimed to evaluate the response rate to Glucantime therapy in children and compare it with adults. One hundred and twelve patients with acute cutaneous leishmaniasis: (ACL) were divided into two equal groups of adults (> 15 yrs) and children (≤ 15 yrs). They received meglumine antimoniate; 20 mg/kg/day for 20 days, their improvement rate was evaluated 20 and 45 days after treatment. Per-protocol analysis showed a significantly lower response in the children group 20 and 45 days after initiation of the treatment (P = 0.0001, 95% confidence interval [CI] = 0.190 [0.079-0.456]/P = 0.0051, 95% CI = 0.317 [0.140-0.717], respectively). Moreover, after intention-to-treat analysis, the same results were seen in the younger group 20 and 45 days after treatment (P = 0.0003, 95% CI = 0.228 [0.098-0.528]/P = 0.0132, 95% CI = 0.382 [0.177-0.825], respectively). According to our results, systemic Glucantime has lower efficacy in treating ACL in children than adults.