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BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), particularly semaglutide, have become the leading anti-obesity drugs for adults, and a similar trend may follow in adolescents with its recent approval for this age group. However, there is a lack of comparative analysis on the weight loss effects and safety of GLP-1 RAs in obese or overweight pediatric and adolescent populations, especially those who are non-diabetic. This systematic review and meta-analysis aim to provide current evidence on the efficacy and safety of GLP-1 RAs as an anti-obesity treatment in obese or overweight non-diabetic pediatric and adolescent populations. METHOD: We searched electronic databases from inception until January 2024 for randomized controlled trials (RCTs) that analyzed the weight loss effect of GLP-1 receptor agonists in adolescents with obesity or overweight without diabetes mellitus. Search results were screened, and eligible studies were included to perform a systematic review and meta-analysis using the Review Manager (RevMan) computer program Version 5.4.1 (The Cochrane Collaboration, 2020) with a random-effects model. The primary efficacy outcomes were changes in body weight, BMI, and BMI Z-score, while the secondary outcomes were the incidence of gastrointestinal adverse events, treatment discontinuation rate due to adverse events, and incidence of serious adverse events. The mean difference, odds ratio, and 95% confidence interval (CI) were used to present the meta-analysis results. Publication bias was visualized using a funnel plot. The quality of the studies was analyzed using Cochrane's Risk of Bias tool (RoB2). RESULTS: A total of seven RCTs with 576 adolescent participants were included in the analysis. GLP-1 RAs significantly achieved greater weight loss than placebo, with a mean difference of -4.98 kg (-8.49, -1.46), I² = 99%, p = 0.006. Subgroup analysis showed that semaglutide had the most pronounced anti-obesity effect (mean difference of -17.70 kg (-18.89, -16.51), p < 0.00001), compared to liraglutide (mean difference of -2.26 kg (-5.17, 0.65), I² = 99%, p = 0.13) and exenatide (mean difference of -3.17 kg (-4.45, -1.90), I² = 0%, p < 0.0001). Similar results were obtained for other efficacy parameters such as BMI and BMI z-score. However, GLP-1 RA was associated with more gastrointestinal adverse events (such as nausea and vomiting) than placebo (3.06 (2.12, 4.42), I² = 0%, p < 0.00001), with incidence comparable among all GLP-1 RAs in the subgroup analysis. The overall risk of bias among included studies was either of 'some concern' or 'high risk.' CONCLUSIONS: Our meta-analysis demonstrated that GLP-1 RAs had a superior anti-obesity effect compared to placebo or lifestyle modification in obese or overweight non-diabetic adolescents, particularly semaglutide, which had a more pronounced anti-obesity effect than liraglutide and exenatide, with tolerable gastrointestinal adverse effects.
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Introduction: More than 28.7 million individuals throughout the globe suffer from diabetes mellitus, with an estimated 11 percent of the population living with the condition in India. Changes in lifestyle and a variety of treatment plans are used in management. Metformin is a key drug for glycemic control, both when used alone and in combination. Our research compares the effectiveness of glycemic control achieved by empagliflozin plus sitagliptin. Methods: This study took place from November 2022 to April 2023 at the tertiary care hospital. The study did not begin until the ethical review was completed. There were two groups of patients, A and B. Everyone received a daily dose of Metformin 1,000 milligrams. Sitagliptin (50 mg twice daily) was administered to individuals in Group A, whereas Empagliflozin (10 mg once daily) was given to those in Group B. After three months of therapy, HbA1c was used to compare the two groups' levels of glycemic control to those at the start of treatment. To do this, we employed a proforma. Version 25 of the Statistical Package for the Social Sciences (SPSS Inc., Chicago, USA) was used for the analysis. Results: The average age of the 300 patients that participated in the trial was 42.33. There were 57.67% men and 42.33% females. "The mean reduction in HbA1c from baseline in Group A was -0.65 ± 0.11% and in Group B was -1.34 ± 0.13% with statistically significant P-value (P-value = 0.000)." Conclusion: The combination of Empagliflozin and Metformin is superior to that of Sitagliptin and Metformin for the maintenance of glycemic control.
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Medical education in India is confronting a charismatic transformation from traditional curriculum to competency-based medical education (CBME). It is more clinically oriented; skill-based and claims to produce competent Indian medical graduates. CBME has divided subjects into competencies and related topics are scattered over different competencies. The intention behind teaching should not be merely students' learning, but contemplation should be towards concept building, imagination, creativity, self-motivated thinking, and the rightful application of knowledge in day-to-day life. Hence a well-formulated, organized, effective, and practically assessable design and an efficient approach are essential not only to link these spread-over pieces of the topic but to teach that topic in a certain flow and rhythm to a medical student also. Therefore, a stepwise approach has been proposed to teach a CBME-driven curriculum to medical students.
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Background Drug promotional literature (DPL) is used as a marketing tactic to publicize the introduction of new medications. As drug companies are promoting the literature for their brand products, bias is possible. Various studies have demonstrated that printed DPLs disseminated by pharmaceutical companies are typically skewed. Material and method A prospective, observational study was carried out in the outpatient departments of a tertiary care hospital to analyze the DPL of different pharmaceutical companies using WHO criteria for "Ethical criteria for medicinal drug promotion, 1988". Results Out of 192 DPLs analyzed, information regarding the generic name, brand name, amount of active ingredient, and manufacturer name was found in all the DPLs (100%). Though therapeutic uses were mentioned in 91% of DPLs, dosage schedule (regimen) was mentioned only in 60%. Drug safety information such as the side effects and significant adverse drug reactions, precautions and warnings, contraindications, and major drug interactions were present in 24%, 36%, and 20%, respectively. Address of the manufacturer and reference to scientific literature were present only in 63% and 53% of DPLs, respectively. References mainly were from journals, present in 71% of DPLs. Most of the claims made in DPLs were regarding efficacy (73%), followed by safety (34%). Conclusion In our study, not a single DPL fulfilled all the nine WHO criteria. A doctor should rigorously evaluate study findings before prescribing because misleading and incorrect information is now frequently found in this literature.
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INTRODUCTION: Statins are well-established agents for dyslipidemia and have successfully been used for the prevention of coronary artery diseases for a long time; this is attributed not only to their lipid-lowering action but also to their pleiotropic actions. Recently many pleiotropic actions of statins have been explored, but very few studies were done to explore statins' antinociceptive action; therefore, the current study was planned to evaluate the antinociceptive activity of Simvastatin in different pain models in mice. MATERIALS AND METHODS: Antinociceptive activity of Simvastatin was evaluated by using Eddy's hot plate method (central analgesic model), acetic acid-induced writhing method (peripheral analgesic model), and biphasic formalin-induced paw licking method. Twenty-four mice were divided into four groups (n = 6 in each): Vehicle control group, simvastatin 5mg/kg, simvastatin 20mg/kg, and positive control group. RESULTS: In the hot plate method, as compared to the vehicle control group, Simvastatin 20mg/kg group showed a significant rise in the reaction time to the corresponding time interval (p<0.001). While the simvastatin 5mg/kg group did not show any significant analgesic activity in the hot plate test. In the acetic acid writhing method, both test groups show a significant delay in the onset of writhing and a decrease in the number of writhes as compared to the vehicle control group (P<0.001). While in the formalin test, both groups show dose-dependent analgesic activity in both the early and late phases. CONCLUSION: Simvastatin exhibits analgesic activity in both central as well as peripheral models of analgesia, but central analgesia shows only at higher concentrations. Similarly, it inhibits inflammatory pain more predominantly than neurogenic, and hence simvastatin can be used in inflammatory conditions like rheumatoid arthritis and osteoarthritis particularly when there is coexisting dyslipidemia.
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Moringa oleifera, known as a miracle tree, is a small plant cultivated all over the world due to its multiple medicinal uses.It is cultivated for its nutritious pods, edible leaves, and flowers which are very helpful as food, medicine, cosmetic oil, and forage for livestock. It is a good source of protein, oils, vitamins, fatty acids, micro-macro mineral elements, and various phenolics. Its roots, bark, gum, leaf, fruit (pods), flowers, seed, and seed oil possess various biological activities. The main flavonoids found in its leaves are myricetin, quercetin, and kaempferol. Each part of the Moringa oleifera tree is used for a variety of nutritional and medicinal purposes. The tree has anti-inflammatory, antimicrobial, antioxidant, anticancer, antihypertensive, hepatoprotective, anti-ulcer, antifertility, and diuretic properties. Its many pharmacological benefits are exploited as therapeutic remedies in the traditional medicinal system for various diseases. Moringa's hypolipidemic, antihypertensive, antioxidant, anti-cancer, anti-diabetic, and hepatoprotective properties have been attributed to quercetin, phenolic acid, tannins, and saponins. More research into this remarkable healer could lead to the creation of new drugs to treat a variety of illnesses. This article gives a quick summary of the medical potential of Moringa and its future as a component of modern medicine. According to the findings of this study, Moringa needs to be properly evaluated before it can be used as a medication in modern medicine.