ABSTRACT
Statins are among the most widely prescribed drugs for treating dyslipidemia and reducing the incidence of heart disease and stroke. However, they come with a wide range of side effects, from myopathy to necrotizing rhabdomyolysis, as well as diabetes, hepatotoxicity, and sleep problems. The most common side effect of statins is statin-induced myopathy, often leading to discontinuation of statin therapy and noncompliance in many patients. This study aims to assess the effectiveness of coenzyme Q10 (CoQ10) supplementation as a treatment for patients with statin-induced myopathy. This systematic review was conducted by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Relevant studies were identified through searches of Medline, PMC, PubMed, Science Direct, and Google Scholar. Only randomized control trials and meta-analyses of oral CoQ10 supplementation versus placebo in adults with statin-associated myalgia were included. The risk of bias was assessed using the Cochrane Risk of Bias tool (The Cochrane Collaboration, London, England, UK) and the measurement tool for the "assessment of multiple systematic reviews" (AMSTAR tool). Out of 5,000 records identified, only five were selected for this review: one meta-analysis and four randomized controlled trials. All of these studies were conducted between 2010 and 2023, involving a total of 800 patients. All randomized controlled trials showed improvement in statin-associated myopathy with CoQ10 supplementation, along with or without a reduced dosage of statins, without any notable side effects of CoQ10. Therefore, it can be deduced that CoQ10 supplementation significantly ameliorates statin-induced musculoskeletal symptoms.
ABSTRACT
Carpal tunnel syndrome (CTS) is a condition that causes discomfort due to the compression of the median nerve in the wrist. Carpal tunnel release (CTR) is a surgical procedure that can help alleviate the symptoms of CTS. Two methods are commonly used for CTR: endoscopic carpal tunnel release (ECTR) and open carpal tunnel release (OCTR). The choice of method can impact surgical outcomes and potential complications. This review aims to compare the outcomes of both methods for individuals diagnosed with CTS. This systematic review analyzes the outcomes and potential complications of ECTR and OCTR for CTS. The study encompassed a comprehensive analysis of randomized controlled trials (RCTs) and meta-analyses comparing both methods. We searched for studies released between January 2012 and October 2023 on PubMed, Science Direct, and Google Scholar. The researchers assessed the quality of studies using the Cochrane risk of bias tool and the AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) tool. The study's scope included a range of outcomes and complications, such as symptom relief, functional recovery, grip strength, return to work, patient satisfaction, scar sensitivity, pillar pain, wound complications, nerve-related issues, morphological changes, and recurrence. The review analyzed 11 studies, including seven RCTs and four meta-analyses. These studies evaluated 4367 ECTR and 4107 cases of OCTR. The patients' ages ranged from 46 to 58, and the follow-up periods ranged from three to 24 months. The findings reveal that ECTR has comparable or better outcomes than OCTR, particularly in postoperative discomfort, functional recovery, grip strength, resumption of work, and patient satisfaction. Additionally, ECTR has lower levels of scar sensitivity, pillar pain, and wound-related complications than OCTR. However, ECTR carries a higher risk of reversible nerve injury. There were no substantial differences between the two techniques regarding other potential complications. Both ECTR and OCTR are safe and effective interventions for CTS. ECTR has benefits like faster recovery and improved cosmetic outcomes but requires higher technical proficiency and carries the risk of nerve injury. The choice of technique should consider patient preference, cost-effectiveness, and surgeon expertise.
ABSTRACT
Ischemic strokes (IS) in young adults often evade early detection, resulting in delayed diagnosis until complications arise. Cervical/vertebral artery dissection, a significant contributor to these strokes, presents with symptoms such as migraine with aura, severe headache, and neck pain, commonly overlooked due to their nonspecific nature. This review investigates early indicators of artery dissections, emphasizing their importance in diagnosis and exploring the correlation between methylenetetrahydrofolate reductase (MTHFR) gene C677T genotype polymorphism, hyperhomocysteinemia (HHCY), and IS in young adults. This systematic review encompasses a thorough analysis of 11 papers, including four observational studies, three case reports, three narrative reviews, and one experimental study, involving 4,840 patients aged 18-45 years. Findings reveal HHCY as a significant contributor to vascular damage and tissue ischemia leading to IS. The MTHFR gene C677T genotype polymorphism is closely associated with HHCY, often contributing to underdiagnosed strokes in young adults. Cervical/vertebral artery dissection may manifest as initial symptoms of neck pain or headache, remaining undiagnosed until imaging is conducted. Importantly, the review suggests that MTHFR gene polymorphism can be mitigated through simple supplementation with vitamin B12 and folates, serving as a valuable tool for primary prevention. Additionally, betaine, a methyl donor, was explored in severe MTHFR gene polymorphism cases resistant to conventional supplementation. In conclusion, recognizing the significance of early signs and symptoms, along with a high clinical suspicion, is crucial for preventing catastrophic outcomes, mortality, and morbidity associated with IS in young adults lacking traditional risk factors. The MTHFR gene C677T genotype polymorphism, a potential genetic cause, can be easily managed with simple measures but is often overlooked or underdiagnosed.