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1.
Cureus ; 15(3): e36754, 2023 Mar.
Article in English | MEDLINE | ID: mdl-37123755

ABSTRACT

There is a developing trend of using wearable electronic devices as health aides, spurred on by telecommunication companies as fitness devices and marketed as such. They have been shown to count steps, pulse, and record arrhythmias, doubling as communication devices and prompting healthcare providers in some instances. We sought to determine if there was a direct correlation between device use and increased physical activity as recommended by the World Health Organization, or if this physical activity increase was only marginal at best. In addition, we sought to investigate if there were additional benefits to using these devices besides increased self-awareness of health. This systematic review used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Keywords for searching articles centered around cardiovascular disease, wearable electronic devices, and their synonyms. Most of the data were obtained from PubMed, although other contributing databases were used, including ResearchGate, Science.gov, ScienceDirect, and PubMed Medical Subject Headings database. Only full-text articles were used. We identified 62 articles that met our search criteria but narrowed them down to 19 following qualitative assessment. Increased physical activity was found to be the one parameter that stood out by way of benefit from the device. Other findings, such as reduced waist circumference, obesity, glycated hemoglobin, and lipid levels, shared mixed results. At this time, we do not have a definition of what duration of device use is deemed standard for health. We have no consensus on which devices are superior health-wise. Our study, however, indicates that these devices, used with adequate health professional supervision, have a role to play in motivation and increased physical activity, enough to cause impactful gains in cardiovascular health.

2.
Cureus ; 15(7): e41398, 2023 Jul.
Article in English | MEDLINE | ID: mdl-37546040

ABSTRACT

High-risk hypertension patients are more susceptible to cardiovascular disease, stroke, and mortality. Monotherapy and triple combination drug therapy are two different approaches to treating hypertension. Monotherapy involves using a single medication to manage hypertension, whereas triple combination therapy involves the simultaneous use of three different antihypertensive medications from different drug classes. Making a fast switch from monotherapy to combination medication is one method to regulate blood pressure (BP) better. It is widely recognized that a significant proportion of individuals with hypertension require combination therapy to manage their condition effectively. This review aims to evaluate the mortality rates across monotherapy and triple combination drug therapy in high-risk hypertension patients. A systematic literature review was conducted across multiple scientific literature repositories. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines for systematic reviews and meta-analyses. Based on the end outcome of each published journal on the effectiveness of triple combination drug therapy as a treatment option for high-risk hypertension patients, there was a notable difference in overall survival, mortality rates, BP reduction, and adherence datasets. Triple combination drug use correlated with increased timeframes for multiple patient survival parameters within the articles shortlisted in this investigation. However, it is crucial for healthcare providers to weigh the risks and benefits of triple combination drug therapy when deciding which treatment approach is best for their patients.

3.
Cureus ; 15(3): e36833, 2023 Mar.
Article in English | MEDLINE | ID: mdl-37123717

ABSTRACT

Multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR TB) is a global concern, with 450,000 new cases and 191,000 deaths in 2021. TB and chronic kidney disease (CKD) have been associated since 1974, with suggested explanations such as oxidative stress, malnutrition, dysfunction in vitamin D metabolism, and a compromised cell-mediated immune response. End-stage renal failure patients are more likely to acquire drug resistance due to poor adherence, adverse drug reactions, and inappropriate dose adjustment. We then aim to evaluate the therapeutic outcome of multidrug-resistant TB of the lungs in patients who require hemodialysis in terms of successful treatment (cured and treatment completed) and the associated factors for a favorable outcome. Our secondary goal is to identify unfavorable treatment outcomes (treatment failed, patient died, or patient lost to follow-up) and the underlying associated factors. We conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 Guidelines for this systematic review. We included adults (>19 years old) with chronic kidney disease who needed hemodialysis and had microbiologically confirmed multidrug-resistant pulmonary TB, excluding patients who had a renal allograft transplant, were on peritoneal dialysis, had extrapulmonary TB, were children and pregnant patients. We searched PubMed, MEDLINE, PubMed Central, ScienceDirect, Public Library of Science (PLOS), and Google Scholar. Keywords were combined with the Boolean "AND" operator to gather results as well as the medical subject heading (MeSH) search strategy. After screening study articles by reading their titles and abstracts, the following tools were used to assess the risk of bias: the Newcastle-Ottawa scale for observational studies, the Assessment of Multiple Systematic Reviews (AMSTAR) checklist for systematic reviews, and the Joanna Briggs Institute (JBI) assessment tool for case reports. Primary and secondary outcomes were assessed, and a conclusion was made. We gathered 21,570 studies from the databases between 2013 and 2023, with 30,062 total participants. There were eight eligible studies for review. Patients with CKD, particularly those on dialysis, are at increased risk of TB due to a combination of factors that contribute to immunosuppression. TB reactivation is common in chronic renal failure patients. Diagnostic samples such as sputum and pleural fluid had lower sensitivity rates compared to tissue samples, which led to delays in diagnosis and treatment and, most importantly, contributed to drug resistance. All new dialysis patients should undergo interferon-gamma release assay testing. TB-infected patients with severe renal disease (eGFR 30 ml/min) had increased morbidity and mortality; however, the use of directly observed treatment, short-course (DOTS), and renal-dose adjustment of anti-TB medications significantly reduced these risks. Drug-induced hepatitis and cutaneous reactions were common adverse effects of anti-TB medications. A therapeutic drug monitoring guideline is required to reduce these adverse events and even mortality. Additional research is required to assess the safety and efficacy of therapeutic regimens, as well as their outcomes, in this population with multidrug-resistant TB.

4.
Cureus ; 15(9): e45000, 2023 Sep.
Article in English | MEDLINE | ID: mdl-37829985

ABSTRACT

Central venous catheter (CVC)-based hemodialysis is a major contributor to bacteremia in immunocompromised hosts. Heparin-locking CVCs is a frequent therapeutic procedure. However, it has not been shown to reduce catheter-related bloodstream infections (CRBSIs). For this systematic review, we searched PubMed, PubMed Central, ResearchGate, Science Direct, and Multidisciplinary Digital Publishing Institute (MDPI) for multiple articles published between January 2018 and January 2023 to determine how antimicrobial locking solutions affect CRBSIs, which could ultimately lower the risk of morbidity, mortality, and hospitalization costs. Antilocking products, catheter-related bacteremia, central-line associated bloodstream infections, tunneled dialysis catheter, hemodialysis, antibiotic, and antimicrobial catheter locks, and the Medical Subject Heading (MeSH) method for PubMed were used as the main keywords for searching publications. A pool of 13 studies with 46,139 individuals showed that the therapy group had a lower incidence of CRBSIs than the heparin-treated control group. Furthermore, it was discovered that bacteria were resistant to gentamicin, and the use of antibiotics had no discernible impact on catheter malfunction. In conclusion, the most effective locking solution to date is an antilocking solution made up of an antibiotic or antimicrobial agent combined with low-dose heparin (500-2,500 U/mL).

5.
Cureus ; 15(10): e46630, 2023 Oct.
Article in English | MEDLINE | ID: mdl-37937003

ABSTRACT

Pancreatic cancer is a malignant tumor with one of the worst prognosis. Its incidence has been on the rise in recent years. First-line and second-line treatments as well as adjuvant therapies have been employed in clinical trials for pancreatic cancer along with traditional chemotherapy and radiotherapy that has been enhanced. The prognosis of pancreatic ductal adenocarcinoma (PDAC) is still quite bad despite recent improvements in diagnostic and treatment methods. Since most patients are not candidates for treatment with a curative purpose, effective palliative care is crucial. For this systematic review, between December 25, 2022, and January 5, 2023, we searched PubMed, Medline, Cochrane, and Science Direct and discovered 225 relevant articles. The appropriateness of the literature abstracts for the pooled analysis was evaluated using different combinations of keywords such as pancreatic cancer, first- and second-line chemotherapy, palliative chemotherapy, gemcitabine and nab-paclitaxel (GnP), FOLFIRINOX (FFX), and fluorouracil. Eight research studies with a total of 15,236 people, including systematic reviews, meta-analyses, and randomized controlled trials (RCTs), were included. The only treatment of choice for patients without metastatic disease who have clinical staging that suggests resectable or borderline resectable pancreatic cancer (BRPC) should be resection. This research examined how first- and second-line chemotherapeutic regimens (using different drug combinations) affected patients with locally advanced pancreatic cancer (LAPC) or BRPC and how they responded in terms of overall survival (OS), tumor resectability, and progression-free interval. The review concludes by highlighting the results of these therapies. Notably, a growing body of research indicates that the two most popular first-line medication combinations GnP and FFX have similar results in RCTs and in real-world populations. Results of second-line therapy after first-line regime failure are still dismal, and there is still a great deal of doubt regarding the best course of action. More RCTs and real-world evidence studies that address current and innovative regimens, as well as the best order in which to administer them, are required, with a greater emphasis on targeted therapy with fewer side effects.

7.
Article in English | MEDLINE | ID: mdl-31241442

ABSTRACT

INTRODUCTION: Bivalirudin and heparin are the two most commonly used anticoagulants used during Percutaneous Coronary Intervention (PCI). The results of Randomized Controlled Trials (RCTs) comparing bivalirudin versus heparin monotherapy in the era of radial access are controversial, questioning the positive impact of bivalirudin on bleeding. The purpose of this systematic review is to summarize the results of RCTs comparing the efficacy and safety of bivalirudin versus heparin with or without Glycoprotein IIb/IIIa Inhibitors (GPI). METHODS: This systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses PRISMA statements for reporting systematic reviews. We searched the National Library of Medicine PubMed, Clinicaltrial.gov and the Cochrane Central Register of Controlled Trials to include clinical studies comparing bivalirudin with heparin in patients undergoing PCI. Sixteen studies met inclusion criteria and were reviewed for the summary. FINDINGS: Several RCTs and meta-analyses have demonstrated the superiority of bivalirudin over heparin plus routine GPI use in terms of preventing bleeding complications but at the expense of increased risk of ischemic complications such as stent thrombosis. The hypothesis of post- PCI bivalirudin infusion to mitigate the risk of acute stent thrombosis has been tested in various RCTs with conflicting results. In comparison, heparin offers the advantage of having a reversible agent, of lower cost and reduced incidence of ischemic complications. CONCLUSION: Bivalirudin demonstrates its superiority over heparin plus GPI with better clinical outcomes in terms of less bleeding complications, thus making it as anticoagulation of choice particularly in patients at high risk of bleeding. Further studies are warranted for head to head comparison of bivalirudin to heparin monotherapy to establish an optimal heparin dosing regimen and post-PCI bivalirudin infusion to affirm its beneficial effect in reducing acute stent thrombosis.


Subject(s)
Acute Coronary Syndrome/drug therapy , Anticoagulants/therapeutic use , Antithrombins/therapeutic use , Heparin/therapeutic use , Peptide Fragments/therapeutic use , Percutaneous Coronary Intervention/methods , Female , Hirudins , Humans , Male , Randomized Controlled Trials as Topic , Recombinant Proteins/therapeutic use , Treatment Outcome
8.
J Dent ; 36(5): 351-9, 2008 May.
Article in English | MEDLINE | ID: mdl-18343013

ABSTRACT

OBJECTIVES: Effective delivery of oral care actives from conventional hydrogel formulations is often compromised by poor retention associated with shear forces present in the mouth, salivary washout and over-hydration of the gel which can lead to structural breakdown and adhesive failure. Non-aqueous gels offer the opportunity to formulate rheologically acceptable vehicles with higher concentrations of bioadhesive polymer than is possible using water as the primary solvent. Accordingly, this study describes the formulation and characterisation of the rheology, hydration and bioadhesive properties of a range of non-aqueous delivery systems (NADS). METHODS: The formulations were composed principally of glycerol, with varying amounts of polyethylene glycol (PEG) 400 and Carbopol 974P being incorporated in the ranges 0-31.34% and 0-4% (w/w). Work of adhesion (WOA) and maximum force of detachment (Fmax) were determined using a Dartec tensile tester after application of a normal force. Rheology was assessed using a Bohlin CS CVO rheometer. RESULTS: WOA and Fmax increased with increasing compression time and Carbopol concentration. Addition of 30% (w/w) PEG 400 to the formulation containing 2% Carbopol in glycerol improved bioadhesive function. Formulation rheology was largely controlled by the Carbopol concentration, and to a lesser extent by the concentration of PEG 400 and these, in turn, largely determined the bioadhesion parameters and rates of hydration. CONCLUSION: The results of this in vitro study suggest that bioadhesion, and consequently potential drug bioavailability, would be enhanced by use of a water miscible non-aqueous delivery vehicle such as glycerol containing a bioadhesive polymer such as Carbopol with the addition of controlled amounts of PEG as plasticiser.


Subject(s)
Drug Delivery Systems/methods , Pharmaceutical Preparations, Dental/administration & dosage , Acrylates/chemistry , Adhesiveness , Adhesives/chemistry , Animals , Chemistry, Pharmaceutical , Drug Carriers/chemistry , Elasticity , Glycerol/chemistry , Humans , Intestinal Mucosa/metabolism , Materials Testing , Pharmaceutical Vehicles/chemistry , Polyethylene Glycols/chemistry , Rats , Rats, Wistar , Rheology , Saliva/metabolism , Saliva, Artificial/chemistry , Solvents/chemistry , Tensile Strength , Viscosity , Water/chemistry
9.
J Dent ; 38(9): 757-64, 2010 Sep.
Article in English | MEDLINE | ID: mdl-20600550

ABSTRACT

OBJECTIVES: Effective delivery of active agents to dental hard tissues is critical to product performance and pertinent to biofilm control, caries, erosion, hypersensitivity and tooth bleaching. The aim of this study was to investigate in vitro the bioadhesion and retention behaviour of non-aqueous delivery systems (NADS) based on glycerol, PEG 400, Carbopol 974P and triclosan. METHODS: Tensile testing was employed to calculate the work of adhesion (WOA) and maximum force of detachment (F(max)) for formulations applied to hydroxyapatite (HA) and pellicle-coated HA surfaces (HAP). Formulation substantivity under conditions of dynamic flow was studied by monitoring the release of incorporated triclosan. The release data were fitted to a first-order model to generate a removal half-life (t(1/2)). RESULTS: Tensile testing showed a clear positive relationship between Carbopol concentration and bioadhesion. Increasing the PEG 400 concentration in formulations containing glycerol, 2% (w/w) Carbopol and 0.30% triclosan produced a local minimum for both WOA and F(max) at 10% (w/w). Values for WOA and F(max) decreased threefold in the presence of a salivary pellicle. Good correlations were obtained between (i) WOA and F(max) and (ii) WOA and t(1/2) and (iii) the elastic modulus of the formulations and t(1/2). CONCLUSION: The presence of a salivary pellicle markedly reduced the bioadhesive interaction between the NADS and the substrate. Increased Carbopol content appeared to be the dominant factor in promoting the WOA, elasticity and retention of NADS to HA surfaces. Such formulations might provide a suitable platform for developing systems suitable for promoting retention to hard surfaces within the oral cavity.


Subject(s)
Durapatite/chemistry , Pharmaceutic Aids/chemistry , Acrylates/chemistry , Adhesiveness , Chemical Phenomena , Chemistry, Pharmaceutical , Chromatography, High Pressure Liquid , Coated Materials, Biocompatible/chemistry , Dental Pellicle/chemistry , Elastic Modulus , Glycerol/chemistry , Humans , Male , Polyethylene Glycols/chemistry , Rheology , Salivary Proteins and Peptides/chemistry , Stress, Mechanical , Surface Properties , Tensile Strength , Triclosan/chemistry
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