RESUMEN
Biologically active derivatives of vitamin A, known as retinoids, can be used to treat cutaneous T-cell lymphomas. Retinoids and their analogs can modulate cell proliferation, differentiation, and apoptosis, and alter the immune response. This study systematically evaluated the safety, efficacy, and tolerability of retinoids for the treatment of cutaneous T-cell lymphomas and considered its limitations, dosing-side effects, and technique with the intent to provide valuable insights for clinicians and patients regarding the treatment of cutaneous T-cell lymphomas with the retinoids. The literature search is conducted using Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) criteria yielding 16 relevant articles. This study explored the different facets of the role of retinoids in the treatment of cutaneous T-cell lymphomas. In conclusion, the available studies and research have shown that retinoids play an important role in the mild and early stages of cutaneous T-cell lymphoma. However, further investigation is required to explain the mechanism of action of retinoids and the impact of their side effects in patients with cutaneous T-cell lymphoma.
RESUMEN
There has been a rise in the prevalence of non-alcoholic steatohepatitis (NASH), a subset of non-alcoholic fatty liver disease (NAFLD) with an ongoing increase in the prevalence of linked conditions such as obesity, type II diabetes mellitus, and metabolic syndrome. To date, there are no specific drugs that are approved for the treatment of NAFLD/NASH. With the recent discovery of association between subclinical hypothyroidism and NASH, various trials exploring treatment options for NASH using thyroid hormone derivatives led to the discovery of resmetirom (MGL-316) with high affinity to thyroid hormone receptors (THRs) targeting the liver. Following standardized guidelines, a systematic review was performed on the safety, efficacy, and other practical aspects of resmetirom in the treatment of NASH. Advanced search was carried out using the MeSH search strategy and appropriate keywords in major databases using various inclusion and exclusion criteria. The search was narrowed down to seven high-quality articles: four randomized control trials (RCTs), and three reviews to be included in the current study. The online database search yielded 62 articles, out of which six high-quality articles were selected to be included in the current systematic review after deleting duplicates and screening for irrelevant titles, and articles. Out of the three RCTs, two of them assessed the safety and efficacy of resmetirom, while the remaining RCT assessed the impact on health-related quality of life with resmetirom on patients with NASH. resmetirom (MGL-316) is a thyroid hormone derivative with high affinity to THRs targeting the liver and acts by improving mitochondrial oxidation, and lipophagy in the hepatic cell line. All the trials suggested in favor of resmetirom with a decrease in NASH fibrosis score by at least two points, along with reduction in hepatic fat content (minimum relative reduction of 20%), liver volume by 61%, improving secondary outcomes such as low-density lipoprotein-C, apolipoprotein-B, triglycerides, and hepatic enzymes with greater reduction in the study groups treated with higher doses of resmetirom with no significant increase in adverse events. Resmetirom was found to improve patient-reported outcomes, and thereby quality-adjusted life years (QALYs) in 12 weeks while being cost-effective compared to placebo at a willingness-to-pay threshold of US$100,000 up to a daily threshold of US$72.00, and an effective incremental cost-effectiveness ratio of US$53,925 per QALY gained. After carefully analyzing the available data by our team members, it could be concluded that resmetirom holds a strong potential to be implemented as a drug of choice in treating NAFLD/NASH in the coming years with proven efficacy, safety while being cost-effective, and also reducing secondary co-morbidities by improving cardiovascular risk factors. The results can be best achieved when combined with conventional approaches such as weight loss and dietary modifications. Long-term safety and sustainability of the achieved results are yet to be confirmed with large-scale clinical trials. However, resmetirom is still an investigational drug and could be expected to be available for clinical practice in the near future.
RESUMEN
Crohn's disease (CD) is a sub-type of inflammatory bowel disease (IBD) with a characteristic relapsing and remitting inflammation involving the gastrointestinal (GI) tract. Although there are several medications to relieve the symptoms, there is no definite cure for the condition. This paper highlights how CD affects our gut flora, which subsequently leads to the perpetuation of inflammation. This review was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines using PubMed, ScienceDirect, Multidisciplinary Digital Publishing Institute (MDPI), and Google Scholar as sources for relevant literature. After applying the quality appraisal tools, we finalized 11 articles for the paper. Inflammation seen in CD leads to dysbiosis, where there is a reduction in beneficial microbes such as Faecalibacterium and Roseburia species and an increase in pathogenic microbes such as Escherichia and Proteus species. This difference in gut microbes disrupts barrier function and immune processes in the intestine, contributing to the worsening of inflammation seen in CD. Several studies have been carried out to understand this complex relationship between the gut microbiome (GM) and CD, as it may serve as a potential novel therapeutic alternative, necessary as CD's burden is increasing globally.
RESUMEN
Cryptogenic stroke refers to a type of ischemic stroke with no identifiable cause despite extensive diagnostic testing. Patent foramen ovale (PFO) treatment modality for the prevention of cryptogenic stroke has been controversial. We undertook this systematic review to compare the efficacy of PFO closure versus medical therapy in preventing recurrent cryptogenic stroke and to provide insight into the most effective treatment modality. Inclusion criteria included patients who had PFO, papers written in English language or had translation available, and papers focusing on medical therapy including drug and surgical treatment for PFO for the prevention of recurrent stroke. Exclusion criteria included articles in which full text could not be obtained and articles in which only one treatment modality was mentioned, either surgical closure or drug therapy. The databases used were PubMed, Cochrane, Embase, and ClinicalTrials.gov. We conducted a bias assessment through the modified Jadad scale for randomized controlled trials (RCTs) and AMSTAR.Ca for meta-analysis and systematic review. The literature search identified a total of 277 papers. After screening, 12 papers were selected for the review. Among these, five were RCTs, five were meta-analyses, one was a systematic review, and one was a systematic review with network meta-analysis. The RCTs included a total of 3,336 participants, while the meta-analyses included 21,813 participants. These finalized papers examined the outcomes of PFO closure compared to medical therapy in preventing recurrent strokes.
RESUMEN
The objective of this meta-analysis was to compare outcomes between sacubitril/valsartan and enalapril in patients with heart failure. We performed this meta-analysis according to the guidelines reported in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Two independent authors systematically searched online databases including PubMed, Cochrane Library, and Web of Science from inception till September 15, 2023. Outcomes assessed in this meta-analysis included all-cause mortality, cardiovascular mortality, and cardiovascular-related hospitalization. A total of nine studies were included in this meta-analysis. Pooled analysis showed that the risk of all-cause mortality was higher in patients receiving enalapril compared to patients receiving sacubitril/valsartan (risk ratio [RR]: 0.57; 95% CI: 0.31 to 1.04). Risk of cardiovascular mortality was significantly higher in the enalapril group compared to the sacubitril/valsartan group (RR: 0.75; 95% CI: 0.62 to 0.91). The risk of cardiovascular hospitalization was significantly higher in the enalapril group compared to the sacubitril/valsartan group (RR: 0.76; 95% CI: 0.66 to 0.86). In conclusion, our meta-analysis of nine studies underscores the superior clinical performance of sacubitril/valsartan compared to enalapril in managing patients with heart failure.