Does home blood pressure monitoring improve blood pressure-related outcomes in people living with chronic kidney disease? A systematic review.

High blood pressure is an important risk factor for cardiovascular disease and disease progression in chronic kidney disease (CKD). Evidence on the effects of home blood pressure monitoring (HBPM) is limited. This review aimed to determine the effect of HBPM on systolic (SBP) and diastolic blood pressure (DBP) in patients with CKD. We searched medical literature databases for eligible studies presenting pre- and post-data for interventions utilizing HBPM. Study quality was assessed using the NHLBI tools for quality assessment. Heterogeneity prohibited a meta-analysis so estimates of effects were calculated along a sign test to examine the probability of observing the given pattern of positive effect direction. Eighteen studies were included (n = 1187 participants, mean age 56.7 [± 7.7] years). In 15 studies, HBPM was conducted within the context of additional high-level tailored support. Overall, the quality of n = 7/18 studies was rated as "good"; n = 6/18 were "fair," and n = 5/18 were rated as "poor." Interventions utilizing HBPM had a significant effect on SBP, with 14/16 studies favoring the intervention (88% [95% CI: 62%-98%], P = .002). Favorable effects were also seen on DBP (73% [95% CI: 45%-92%], P = .059). HBPM had a favorable effect on blood pressure goal attainment (86% [95% CI: 42%-100%], P = .062). HBPM in patients with CKD as part of a multicomponent intervention may lead to clinically significant reductions in blood pressure; however, research is needed to support the validity of this claim due to the high heterogeneity across the studies included.

Incidence of rhabdomyolysis occurrence in psychoactive substances intoxication: a systematic review and meta-analysis.

Rhabdomyolysis is a potentially life-threatening condition induced by diverse mechanisms including drugs and toxins. We aimed to investigate the incidence of rhabdomyolysis occurrence in intoxicated patients with psychoactive substances. In this review, three databases (PubMed, Scopus, Web of Science) and search engine (Google Scholar) were searched by various keywords. After the screening of retrieved documents, related data of included studies were extracted and analyzed with weighted mean difference (WMD) in random effect model. The highest incidence of rhabdomyolysis was observed in intoxication with heroin (57.2 [95% CI 22.6-91.8]), amphetamines (30.5 [95% CI 22.6-38.5]), and cocaine (26.6 [95% CI 11.1-42.1]). The pooled effect size for blood urea nitrogen (WMD = 8.78, p = 0.002), creatinine (WMD = 0.44, p < 0.001), and creatinine phosphokinase (WMD = 2590.9, p < 0.001) was high in patients with rhabdomyolysis compared to patients without rhabdomyolysis. Our results showed a high incidence of rhabdomyolysis induced by psychoactive substance intoxication in ICU patients when compared to total wards. Also, the incidence of rhabdomyolysis occurrence was high in ICU patients with heroin and amphetamine intoxication. Therefore, clinicians should anticipate this complication, monitor for rhabdomyolysis, and institute appropriate treatment protocols early in the patient's clinical course.

Exposure to Polycyclic Aromatic Hydrocarbons and adverse reproductive outcomes in women: current status and future perspectives.

OBJECTIVES: Polycyclic Aromatic Hydrocarbons (PAHs) are ubiquitous, toxic environmental chemicals that can cause adverse reproductive health effects. The objectives of this mini-review are to highlight the adverse reproductive outcomes due to PAH exposure with the main focus on polycystic ovary syndrome (PCOS) and premature ovarian failure (POF) and to provide perspectives on future research needs. CONTENT: We reviewed studies that have reported the adverse reproductive outcomes associated with PAHs exposures in women through a comprehensive search of bibliographic databases and gray literature sources. In addition, potentially modifiable sources of exposure to PAHs and associated reproductive outcomes were also investigated. SUMMARY: A total of 232 papers were retrieved through a comprehensive search of bibliographic databases, out of which three studies met the eligibility criteria and were included in the review. Results showed that exposure to PAHs is associated with adverse reproductive outcomes defined as PCOS, POF, and reproductive hormone imbalance. Sources of PAH exposure associated with adverse reproductive outcomes include active and passive tobacco smoking, specific cooking methods, and pesticides. OUTLOOK: Future studies are warranted to examine the mechanisms by which PAHs result in adverse reproductive endpoints in women. Further, environmental exposures that are potentially modifiable such as exposure to tobacco smoke, may contribute to PAH exposure, and these exposures should be targeted in future policies and interventions.

Anti-cancer peptide-based therapeutic strategies in solid tumors.

BACKGROUND: Nowadays, conventional medical treatments such as surgery, radiotherapy, and chemotherapy cannot cure all types of cancer. A promising approach to treat solid tumors is the use of tumor-targeting peptides to deliver drugs or active agents selectively. RESULT: Introducing beneficial therapeutic approaches, such as therapeutic peptides and their varied methods of action against tumor cells, can aid researchers in the discovery of novel peptides for cancer treatment. The biomedical applications of therapeutic peptides are highly interesting. These peptides, owing to their high selectivity, specificity, small dimensions, high biocompatibility, and easy modification, provide good opportunities for targeted drug delivery. In recent years, peptides have shown considerable promise as therapeutics or targeting ligands in cancer research and nanotechnology. CONCLUSION:  This study reviews a variety of therapeutic peptides and targeting ligands in cancer therapy. Initially, three types of tumor-homing and cell-penetrating peptides (CPPs) are described, and then their applications in breast, glioma, colorectal, and melanoma cancer research are discussed.

Curcumin as a preventive or therapeutic measure for chemotherapy and radiotherapy induced adverse reaction: A comprehensive review.

Curcumin has attracted much attention for medicinal purposes in wide range of illnesses including cancer. In some studies, its efficacy is evaluated against chemotherapy and radiotherapy induced adverse reaction and also as adjuvant to cancer treatment. Here we have tried to present a comprehensive review on protective and therapeutic effect of curcumin against these side effects. METHOD: The data were collected by searching Scopus, PubMed, Medline, and Cochrane database systematic reviews, using key words "nephrotoxicity", "cardiotoxicity", "genotoxicity", "ototoxicity", "hepatotoxicity", "reproductive toxicity", "myelosuppression", "pulmonary toxicity", "radiotherapy induced side effect" with "turmeric" and "curcumin". Although curcumin has low bioavailability, it has shown brilliant profile on prevention and management of chemotherapy and radiotherapy induced adverse reactions, particularly based on in vitro and in vivo studies and limited number of human studies on radiotherapy adverse reactions. Antioxidant and anti-inflammatory properties of the curcumin are the main proposed mechanism of action for management and prevention of adverse reactions. One of the major points regarding the protective effect of curcumin is its wide tolerable therapeutic range of dose with minimal side effects. Furthermore, new nano-formulations help to improve the bioavailability, increase in efficacy and lower the adverse effects. In conclusion, based on the present knowledge, curcumin has significant supportive potential in patients receiving chemotherapy or radiotherapy and may be suggested as adjutant with cancer treatments. Further well-designed human studies are recommended.

Medical therapy versus percutaneous coronary intervention in ischemic heart disease: A cost-effectiveness analysis.

Background: Ischemic heart disease is categorized into two acute and chronic groups, and its treatments include revascularization and medical therapy. The aim of this study is to evaluate the economic burden of medical therapy compared to percutaneous coronary intervention in ischemic heart disease. Methods: This study has been done in two steps. The first was a systematic review and meta-analysis to measure the effectiveness of two interventions and the second step was a cost-effectiveness analysis from the perspective of society. The data analysis included a meta-analysis and the Markov cohort simulation. RewMan v5 and tree age software were utilized. Uncertainties related to the model parameters were evaluated using one-way and two-way sensitivity analyses. Results: Regarding the effectiveness of interventions, the odd ratio of the quality of life in the medical therapy group (CI: 0.76-1.10) was 0.91 times the PCI group (p=0.34). This rate for mortality in medical therapy (CI: 0.52-9.68) was 2.23 times more than the PCI group; this result was not significant (p=0.02). In the cost-effectiveness analysis, the cost-effectiveness threshold was $ 16,482; ICER in increasing the QoL and reduction in the mortality rate was $ 25320.11 and $ 562.6691, respectively. Regarding the sensitivity analysis, the model was not sensitive in changing parameters in a specific domain. Conclusion: According to this study, PCI is more cost-effective than medical therapy in the reduction of mortality rate and in the field of increasing quality of life. MT strategy is more cost-effective than the PCI. This study considers controversies regarding the most appropriate treatment for patients with ischemic heart disease that is helpful for health policymakers, cardiologists and health managers.

Environmental chronic exposure to metals and effects on attention and executive function in the general population.

Heavy metals are neurotoxic, associated with brain dysfunction, and have been linked with cognitive decline in adults. This study was aimed to characterize chronic exposure to metals (Cd, Be, Co, Hg, Sn, V, Al, Ba, Cr, Cu, Fe, Li, Mn, Ni, Pb, and Zn) and metalloids (As, B, Sb) and assess its impact on cognitive performance of Tehran's residents, capital of Iran. Scalp hair samples gathered from 200 volunteered participants (110 men and 90 women), aged 14-70 years and quantified by inductively coupled plasma atomic emission spectroscopy (ICP-OES). Attention and executive function, two measures of cognitive performance, were characterized using the trail making test (TMT) part A and B, respectively. Mental flexibility was characterized as the Delta TMT B-A scores and cognitive efficiency or dissimulation as the ration between TMT B and A scores. A comprehensive questionnaire was used to gather information on demographic and socioeconomic as well as lifestyle and health status. The highest and lowest mean concentrations were observed for B (325 µg/g) and As (0.29 µg/g), respectively. Results indicated that chronic metal exposure measured in hair changed significantly based on gender and age (p < 0.05). The levels of Cr, Fe, Ni, Si, Hg, Pb and B were significantly higher in males' hair, whereas those of Ag and Ba were greater in females' hair (p < 0.05). The results of the cognitive TMT test were significantly different between gender and age groups (p < 0.05). Moreover, results revealed that As, Hg, Mn, and Pb levels in hair were significantly associated with poorer participants' performance scores in the TMT test (p < 0.05). Age, gender, cigarette smoking, water-pipe smoking, traffic density in the area of residence, and dental amalgam filling were significant factors affecting the TMT test scores. The results suggest that chronic exposure to metals has detrimental effects on attention, executive function, mental flexibility and cognitive efficiency.