RESUMEN
Cardiovascular disease is the leading cause of mortality and morbidity worldwide. One of the main risk factors for cardiovascular events is hypertension. The use of antihypertensive drugs can protect against these events. It occurs directly through the control of hypertension and indirectly through other cardiovascular effects. This meta-analysis and systematic review aimed to assess the impact of various antihypertensive medications (ACE inhibitors, beta-blockers, calcium channel blockers, diuretics, etc.) on blood pressure and various cardiovascular outcomes. A thorough search was conducted using several online databases and search engines, including PubMed, Google Scholar, ScienceDirect, Medline, Embase, and others. RCTs evaluating the impact of antihypertensive medications on BP and other cardiovascular events like coronary heart disease and stroke were included in this study. Included were studies detailing the use of antihypertensive medication in monotherapy. The meta-analysis was done using RevMan version 5.4 software (Cochrane Collaboration, London, UK). Means and standard deviations were extracted for the continuous variables and events, and the total sample number was extracted for the dichotomous variables. This analysis encompassed a total of 18 RCTs of the elderly population. The data for each variable was extracted independently, and analysis was performed. Overall, systolic blood pressure (SBP) revealed an impact of -11.88, CI=95% (-20.56, -3.19). The diastolic blood pressure (DBP) showed -5.41, CI=95% (-9.62, -1.20), myocardial infarction 0.92, CI=95% (0.82, 1.04), stroke 0.83, CI=95% (0.74, 0.94), and cardiovascular mortality 0.93, CI=95% (0.86, 1.00). Heterogeneity was present due to the variable sample size of the studies and other unidentified biases. In conclusion, there was a significant reduction in the elderly population's risk of stroke, myocardial infarction, and cardiovascular death when antihypertensive medications were taken.
RESUMEN
Autoimmune hepatitis (AIH) is a hepatocellular disorder thought to be caused by an immune system that cannot tolerate autoantigens specific to hepatocytes. This study aims to evaluate the efficacy of using corticosteroids (prednisolone and azathioprine) as a combination therapy in treating AIH. This study aims to synthesize and analyze existing evidence to inform clinical practices concerning the overall clinical efficacy of this treatment approach in managing AIH. A comprehensive search was conducted across multiple online databases and search engines, including PubMed, Google Scholar, ScienceDirect, Medline, and Embase. RevMan 5.4 software was used for meta-analysis, with forest plots created for each outcome. Thirteen studies were included in this systematic review and meta-analysis. The results indicate that the combination of prednisolone and azathioprine for treating AIH leads to less recurrence and better disease control.
RESUMEN
An effective anticoagulation therapy is required for patients with atrial fibrillation because it presents a significant risk of stroke. The current study evaluates the relative safety as well as efficacy of rivaroxaban in patients who are diagnosed with atrial fibrillation. A thorough literature review of relevant databases was conducted, focusing on academic and clinical studies that were published from 2017 onward. Inclusion criteria comprised randomized controlled trials and other observational studies comparing the incidence of stroke and the safety index of rivaroxaban in atrial fibrillation. We followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) for data overview reporting and overview. A total of 21 studies were selected based on the inclusion criteria. A total of 19/21 studies advocated the adoption of rivaroxaban for minimizing stroke incidence. Rivaroxaban also showed superiority in achieving the therapeutic objectives, i.e., reduction in the incidence of stroke. The results for rivaroxaban against warfarin showed an improved safety index and effectiveness of rivaroxaban. The total effect size for the analysis was calculated to be Z=2.62 (p-value=0.009). The individual effect of all studies favored the "rivaroxaban" group. The heterogeneity in the study was as follows: tau2=0.10; chi2=110.10, df=6; I2=95%. The second analysis for risk reduction and incidence of stroke after rivaroxaban therapy also showed a bias towards rivaroxaban therapy. The combined effect for the analysis was found to be as follows: HR=0.73 ((95% CI: 0.50, 1.07). The total effect was calculated to be Z=1.61 (p-value= 0.10). The heterogeneity was found to be as follows: tau2= 0.20, chi2=89.97, df=6, I2=93%. Standard dosing of rivaroxaban emerges as a preferred strategy for stroke prevention, balancing efficacy and safety. Clinical decision-making should consider individual patient characteristics and future research should delve into specific subpopulations and long-term outcomes to further refine treatment guidelines.
RESUMEN
Inflammatory bowel disease (IBD)is an extremely common gastrointestinal disorder that can give rise to dysplasia and colorectal cancer (CRC). There are various diagnostic methods but endoscopy has proved to be the best in the diagnosis, monitoring, and treatment of IBD. The objective of this review is to evaluate the efficacy of endoscopy in detecting patients with IBD. A structured search strategy on PubMed, Science Direct, and Google Scholar was used, as well as formal inclusion or exclusion, data extraction, validity assessment, and meta-analysis. RevMan 5.4 (Review Manager (RevMan) (Computer program). Version 5.4. The Cochrane Collaboration, 2020) was used for the meta-analysis, and forest plots were generated for each outcome separately. All of these studies are prospective cohorts and 11 of these are randomized controlled trials (RCTs). In IBD, both chromoendoscopy and white light endoscopy are useful in detecting dysplasia and neoplastic lesions. Furthermore, narrow-band imaging is a less time-consuming option for endoscopic surveillance. The meta-analysis also showed that chromoendoscopy is superior to other methods.
RESUMEN
BACKGROUND: Vascular Endothelial Growth Factor (VEGF) is regulated by a number of different factors, but the mechanism(s) behind androgen-mediated regulation of VEGF in prostate cancer are poorly understood. RESULTS: Three novel androgen receptor (AR) binding sites were discovered in the VEGF promoter and in vivo binding of AR to these sites was demonstrated by chromatin immunoprecipitation. Mutation of these sites attenuated activation of the VEGF promoter by the androgen analog, R1881 in prostate cancer cells. The transcription factors AR and Sp1 were shown to form a nuclear complex and both bound the VEGF core promoter in chromatin of hormone treated CWR22Rv1 prostate cancer cells. The importance of the Sp1 binding site in hormone mediated activation of VEGF expression was demonstrated by site directed mutagenesis. Mutation of a critical Sp1 binding site (Sp1.4) in the VEGF core promoter region prevented activation by androgen. Similarly, suppression of Sp1 binding by Mithramycin A treatment significantly reduced VEGF expression. CONCLUSIONS: Our mechanistic study of androgen mediated induction of VEGF expression in prostate cancer cells revealed for the first time that this induction is mediated through the core promoter region and is dependent upon a critical Sp1 binding site. The importance of Sp1 binding suggests that therapy targeting the AR-Sp1 complex may dampen VEGF induced angiogenesis and, thereby, block prostate cancer progression, helping to maintain the indolent form of prostate cancer.