scholarly journals Obesity, non-alcoholic fatty liver disease, COVID-19: dangerous liaisons

2021 ◽  
pp. 76-83
Author(s):  
S. V. Tikhonov ◽  
V. D. Dekkanova ◽  
S. A. Vinnichuk ◽  
T. S. Fil ◽  
N. V. Bakulina
Keyword(s):  
Kinase Inhibitors ◽  
Fatty Degeneration ◽  
Evidence Base ◽  
Sufficient Evidence ◽  
Blood Oxygen Saturation ◽  
Biological Drugs ◽  
Alcoholic Fatty Liver ◽  
Pathogenetic Therapy ◽  
Coronavirus Infection ◽  
Medical Histories

The pandemic of COVID-19 is changing the usual clinical practice. Most of the drugs used for the etiotropic and pathogenetic therapy of COVID-19 do not have a sufficient evidence base, approaches to therapy of liver, gastrointestinal tract and other body systems damage in the structure of COVID-19 and post COVID-19 syndrome are under development. Coronavirus infection is more severe in  obese patients with associated diseases; the  liver plays an important role in  this process. Retrospective analysis of  the  medical histories of  patients with a  new coronavirus infection hospitalized in  the  clinic of North-Western State Medical University named after I.I. Mechnikov identified that 34.7% of patients were overweight, 51.3% obese, 77% abdominal obesity (alanine aminotransferase (ALAT) was on average 76.2 ± 58.8 U/L, aspartate aminotransferase (ACAT) 60.7 ± 48.6 U/L). At the time of hospitalization, increased transaminases was detected in 71% of patients and correlated with markers of the severe course of COVID-19 (the level of C-reactive protein, ferritin, % of blood oxygen saturation). In patients with severe new coronavirus infection, receiving therapy with JAK-kinase inhibitors and/or biological drugs, often was a  significant increase of  ALAT and ASAT up to 5–10  upper limits of  the  norm. In  the  process of  histological examination of the liver tissue of patients who died of extremely severe course of infection, characteristic fatty degeneration of hepatocytes was revealed. Therapy with a multicomponent drug containing inosine, meglumine, methionine, nicotinamide and succinic acid contributed to a dynamic decrease of transaminases and an improvement in the course of the new coronavirus infection. 

scholarly journals Systematic review of evidence underpinning non-pharmacological therapies in dementia

2018 ◽  
Vol 42 (4) ◽  
pp. 361 ◽  
Author(s):  
Richard Olley ◽  
Andrea Morales
Keyword(s):  
Systematic Review ◽  
Sleep Disturbances ◽  
Research Effort ◽  
Evidence Base ◽  
Pharmacological Therapy ◽  
Sufficient Evidence ◽  
Behavioural Treatment ◽  
Significant Research ◽  
Research Gap ◽  
Meta Analyses

Objective Dementia is one of the most common illnesses worldwide, and is one of the most important causes of disability in older people. Currently, dementia affects over 35 million people around the globe. It is expected that this number will increase to 65.7 million by 2030. Early detection, diagnosis and treatment to control the principal behaviour symptoms may help reduce these numbers and delay the progression to more advanced and dangerous stages of this disorder with resultant increase quality of life for those affected. The main goal of the present systematic literature review was to examine contemporary evidence relating to non-pharmacological therapy in the treatment of dementia. Methods To achieve the study goal, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used. Results This study identified the five most common behaviours in patients with dementia as aggression, wandering, agitation, apathy and sleep disturbances. Two non-pharmacological therapies were the most studied treatment: music therapy and aromatherapy. Ten other non-pharmacological therapies were also identified, but these lack a sufficient evidence-base. Conclusion Although all the therapies identified could be used as part of the treatment of behavioural symptoms, there is insufficient evidence relating to the indications, appropriate use and effectiveness of these therapies to apply in each behavioural treatment. Thus, the present study has demonstrated a significant research gap. What is known about the topic? Despite the widespread use of many different types of therapies, there is limited evidence regarding the efficacy of non-pharmaceutical therapies deployed in the management of behaviours of concern manifested by some people who suffer with dementia in all its forms. What does this paper add? This systematic review examines contemporary evidence from the literature to determine whether there is an evidence base available that would underpin the use of these therapies. This report on a PRISMA systematic review of the available literature demonstrates that only two therapies have some evidence to underpin the use of these non-pharmaceutical therapies and that a significant research gap is exists. What are the implications for practitioners? The implications for practitioners is that significant research effort is required to determine the efficacy of many of the therapies that are currently deployed, and thus many of the therapies used lack an evidence base at this time.

scholarly journals Efficacy of Non-Halofuginone-Based Strategies to Prevent or Treat Cryptosporidiosis in Bovine Calves: A Systematic Review

2020 ◽  
Author(s):  
Julii Brainard ◽  
Charlotte C. Hammer ◽  
Kevin Tyler ◽  
Paul R. Hunter
Keyword(s):  
Systematic Review ◽  
Weight Gain ◽  
Kinase Inhibitors ◽  
Management Strategies ◽  
Evidence Base ◽  
High Morbidity ◽  
Case Control Studies ◽  
Nutritional Strategy ◽  
Before And After ◽  
Meta Analyses

Cryptosporidiosis is a common illness in young cattle that causes high morbidity and some mortality. A common prophylactic treatment are halofuginone products but it seems likely disease could be reduced by other other pharmacological products or some management strategies. We undertook a systematic review and meta-analyses on key outcomes for treatment of calves before and after 5 days of age with any management strategy, any nutritional strategy or any non-halofuginone product. A systematic literature search was undertaken with data extracted for outcomes = oocyst shedding, diarrhea, mortality and weight gain. Experiments had to describe results for same age animals in contemporary arms. Control animals had to be observed concurrently in planned experiments (pre-post and case-control studies were not eligible). Both randomized and other clinically controlled trials were eligible. Results were subgrouped by study design and outcomes were described in detail where at least two articles described the same treatment strategy. 55 articles were found. Significantly lower incidence of oocyst shedding, diarrhea burden and mortality was reported in many experimental arms, especially when animals started treatment before 5 days old. Weight gain was not mostly affected by treatment, however, by three weeks of age. The evidence base is at least encouraging but insufficient about paromomycin, bumped kinase inhibitors and azithromycin treatment, especially for diarrhea and oocyst shedding, given late or early. Azithromycin is the most promising of these.

scholarly journals Do protocols for new randomised trials take previous similar trials into account? Cohort study of contemporary trial protocols

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e026661
Author(s):  
Asger Sand Paludan-Müller ◽  
Michelle C Ogden ◽  
Mikkel Marquardsen ◽  
Jonas Vive ◽  
Karsten Juhl Jørgensen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Literature Search ◽  
Evidence Base ◽  
Sufficient Evidence ◽  
Randomised Trials ◽  
Literature Searches ◽  
Trial Protocols ◽  
Ethical Approval ◽  
Simple Search ◽  
Systematic Literature Searches

ObjectiveTo investigate to what extent evidence from previous similar trials or systematic reviews was considered before conducting new trials.DesignCohort study of contemporary protocols for trials with ethical approval.MethodsAll protocols for randomised trials approved by the five ethical committees in Denmark between January 2012 and March 2013 were screened for eligibility. Included protocols were read in full to determine whether a systematic search had been conducted and references were checked to evaluate whether trial rationale and design could be challenged for not adequately considering previous evidence. To investigate whether protocols cited relevant trials, we used simple search strategies that could easily be conducted by researchers without experience with literature searches.ResultsSixty-seven protocols were included. Only two (3%) of the protocols explicitly stated to have conducted a literature search and only one (1%) provided information that allowed the search to be replicated. Eleven (16%) of the protocols described trials where we found the information insufficient to judge if the trial was ethically justified, either due to a comparator that was not supported by the presented evidence (six protocols), because they did not present a rationale for conducting the trial (two protocols), or for both reasons (three protocols). For eight (12%) of the protocols, our search identified trials that could have been relevant to cite as justification.ConclusionsWhile most protocols seem to adequately consider existing evidence, a substantial minority of trials might lack a sufficient evidence base. Very few trials seemed to have been based on a literature search which makes it impossible to know whether all relevant previous trials had been considered. Rules for ethical approval should include requirements for systematic literature searches to ensure that research participants are not exposed to sub-optimal treatments or unnecessary harms as well as to reduce research waste.

scholarly journals Is there sufficient evidence regarding signage-based stair use interventions? A sequential meta-analysis

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e012459 ◽  
Author(s):  
Adrian Bauman ◽  
Karen Milton ◽  
Maina Kariuki ◽  
Karla Fedel ◽  
Mary Lewicka
Keyword(s):  
Physical Activity ◽  
Meta Analysis ◽  
Population Level ◽  
Evidence Base ◽  
Effect Sizes ◽  
Sufficient Evidence ◽  
Small Scale ◽  
Research Translation ◽  
Policy And Practice ◽  
Stair Use

ObjectiveThe proliferation of studies using motivational signs to promote stair use continues unabated, with their oft-cited potential for increasing population-level physical activity participation. This study examined all stair use promotional signage studies since 1980, calculating pre-estimates and post-estimates of stair use. The aim of this project was to conduct a sequential meta-analysis to pool intervention effects, in order to determine when the evidence base was sufficient for population-wide dissemination.DesignUsing comparable data from 50 stair-promoting studies (57 unique estimates) we pooled data to assess the effect sizes of such interventions.ResultsAt baseline, median stair usage across interventions was 8.1%, with an absolute median increase of 2.2% in stair use following signage-based interventions. The overall pooled OR indicated that participants were 52% more likely to use stairs after exposure to promotional signs (adjusted OR 1.52, 95% CI 1.37 to 1.70). Incremental (sequential) meta-analyses using z-score methods identified that sufficient evidence for stair use interventions has existed since 2006, with recent studies providing no further evidence on the effect sizes of such interventions.ConclusionsThis analysis has important policy and practice implications. Researchers continue to publish stair use interventions without connection to policymakers' needs, and few stair use interventions are implemented at a population level. Researchers should move away from repeating short-term, small-scale, stair sign interventions, to investigating their scalability, adoption and fidelity. Only such research translation efforts will provide sufficient evidence of external validity to inform their scaling up to influence population physical activity.

scholarly journals Baricitinib in the Treatment of Patients with COVID-19: A Review of International Data and Analysis of Clinical Results in the Russian Population

2021 ◽  
Vol 66 (1-2) ◽  
pp. 47-56
Author(s):  
А. I. Zagrebneva ◽  
Е. А. Baryakh ◽  
Е. I. Zhelnova ◽  
N. G. Poteshkina ◽  
I. Р. Beloglazova ◽  
...  
Keyword(s):  
Clinical Results ◽  
Point Of View ◽  
Janus Kinase ◽  
Early Warning Score ◽  
Reversible Inhibitor ◽  
Clinical Use ◽  
Blood Oxygen Saturation ◽  
Mean Values ◽  
Average Value ◽  
Pathogenetic Therapy

The effects of baricitinib, a selective reversible inhibitor of Janus kinase 1 and 2, in the treatment of COVID-19 are associated with different aspects of pathogenesis — inhibition of viral endocytosis, reduction of excessive inflammatory response, and mitigation of vascular and pulmonary damage, which is a strong rationale for using baricitinib to treat patients with COVID-19. In the period from April to May 2020, City Clinical Hospital No. 52 obtained clinical experience of baricitinib clinical use in the therapy of 113 patients with COVID-19: 58 (51%) women and 55 (49%) men, whose average age was 57±12.6 years old. Analysis of the results of using baricitinib showed that therapy with baricitinib against the background of standard pathogenetic therapy was found to be effective in 95 (84%) patients and ineffective in 18 (16%). Significant positive changes were shown in comparison with the baseline level of the following indicators: body temperature (from 37.2±0.8˚C to 36, ±0.68˚C, P=0.000), blood oxygen saturation (from 95.5±3.0% to 96.5±2.2%, P=0.011), C-reactive protein (from 46.1±48.0 mg/L to 33.5±43.7 mg/L, P=0.010 ), National Early Warning Score (NEWS) (from 1.7±1.3 to 1.1±1.2, p=0.001). From the safety point of view, patients showed a slight decrease in the average value of the number of neutrophils — from (3.1±1.4)×109 to (3.0±2.0)×109 and lymphocytes — from (1.8±0,9)×109 to (1.7±0.9)×109, as well as minimal multidirectional changes in the mean values of transaminase activity — alanine aminotransferase changed from 33.9±23.6 U/L to 34.9±47.5 U/L, aspartate aminotransferase — from 40.6±49.0 U/L to 38.5±25.5 U/L. In general, the results obtained within the experience of the clinical use of baricitinib in 113 Russian patients with COVID-19 are consistent with the available data from foreign clinical studies and confirm the efficacy and safety of baricitinib.  

scholarly journals Hepatoprotective properties of glycyrrhizic acid

2020 ◽  
pp. 96-108
Author(s):  
S. V. Okovity ◽  
K. L. Raikhelson ◽  
A. V. Volnukhin ◽  
D. A. Kudlai
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Intrahepatic Cholestasis ◽  
Fatty Liver Disease ◽  
Glycyrrhizic Acid ◽  
Evidence Base ◽  
Alcoholic Fatty Liver ◽  
Organ Systems ◽  
Wide Range ◽  
Alcoholic Fatty Liver Disease

The review is devoted to the problem of treatment of non-alcoholic fatty liver disease, which is the most common pathology of the hepato-biliary system worldwide and is characterized by an increasing frequency, including of more severe forms. A wide range of pathogenetic relationships of non-alcoholic fatty liver disease with diseases of other organ systems, primarily with diseases of the cardiovascular system, type 2 diabetes mellitus, chronic kidney disease and diseases of the biliary tract, is presented. The main mechanisms of comorbidity are insulin resistance, oxidative stress, inflammation, disorders of carbohydrate and fat metabolism. An approach to the therapy of this disease based on the concept of comorbidity has been substantiated. As a rational therapeutic choice, a molecule of glycyrrhizic acid is presented, which has pleiotropic effects, including anti-inflammatory, antioxidant, antifibrotic and immunomodulatory effects. The evidence base for glycyrrhizic acid is formed by a large array of clinical trials, including randomized placebo-controlled trials conducted both in Russia and abroad, in infectious and non-infectious liver diseases, including non-alcoholic fatty liver disease. Attention is focused on non-alcoholic fatty liver disease with intrahepatic cholestasis associated with a more severe course and high rates of disease progression. A theoretical justification for the use of a combination of glycyrrhizic acid and ursodeoxycholic acid in such patients is presented. The reason for this is the potential synergy of the two molecules, based on the induction of CYP3A4, and associated with the effect on inflammation, as a factor in the development of intrahepatic cholestasis and cholestasis itself.

scholarly journals Use of Janus kinase inhibitors in the treatment of immunoinflammatory rheumatic diseases: safety issues

2021 ◽  
pp. 76-84
Author(s):  
B. S. Belov ◽  
N. V. Muravyeva ◽  
G. M. Tarasova ◽  
M. M. Baranova
Keyword(s):  
Rheumatic Diseases ◽  
Kinase Inhibitors ◽  
Infectious Complications ◽  
Genetically Engineered ◽  
Janus Kinase ◽  
Biological Drugs ◽  
Janus Kinase Inhibitors ◽  
Safety Issues ◽  
European League Against Rheumatism ◽  
Poor Tolerance

There has been clear progress in rheumatology in recent decades with the introduction of genetically engineered biological drugs (GEBDs) as well as targeted baseline anti-inflammatory drugs, which include Janus kinase inhibitors (i-JAKs). To date, i-JAKs have been actively used and studied in various immunoinflammatory rheumatic diseases (IIRDs) – rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis (AS), as well as psoriasis, atopic dermatitis and inflammatory bowel disease. In order to summarize the accumulated experience, the experts of the European League Against Rheumatism developed a consensus, which outlined the main principles and provisions concerning the rational use of i-JAKS in patients with IIRDs. At the same time, much attention is paid to the problem of the safety of these drugs. In the present article, issues related to various aspects of the safety of the use of i-JAKs in patients with IIRDs are discussed in detail, namely: dose adjustments due to drug interactions, contraindications, pre-screening, and risk assessment. Possible adverse events related to infectious complications, malignancies, thromboembolic phenomena, and gastrointestinal perforation were analyzed. The significance of clinical and laboratory monitoring in catamnestic follow-up of patients receiving i-JAKs is emphasized. A program for further research on the mentioned problem is presented. It includes studies of the efficacy and safety of «switching» between i-JAKs in patients with poor tolerance of a particular drug or who do not respond to treatment, evaluation of the effect of i-JAKs on comorbidities including cardiovascular disease and osteoporosis, studies of the long-term safety of i-JAKs based on actual practice data, and of the effectiveness and safety of i-JAKs and GEBDs combination therapy in patients with severe RA or other conditions, etc. This consensus is designed to inform and target physicians seeking to achieve optimal use of these drugs in patients with IIRDs, as well as patients themselves and other interested parties, including facility administrators. The recommendations will undoubtedly be expanded and supplemented as new data accumulate.

scholarly journals ALBUMINURIA AS A MARKER OF ENDOTHELIAL DYSFUNCTION AND EARLY PREDICTOR OF CARDIOVASCULAR COMPLICATION IN PATIENTS WITH DIABETES MELLITUS

2016 ◽  
Vol 57 (3) ◽  
pp. 7-16
Author(s):  
N. A. Kravchun ◽  
O. V. Zemlianitsyna ◽  
I. V. Cherniavskaya ◽  
Yu. I. Karachentsev
Keyword(s):  
Type 2 Diabetes ◽  
Glomerular Filtration Rate ◽  
Endothelial Dysfunction ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Cardiovascular Complication ◽  
Alcoholic Fatty Liver ◽  
Patients With Diabetes ◽  
Pathogenetic Therapy

The necessity to identify was grounded and assesses the dynamics of albuminuria and glomerular filtration rate in patients with type 1 and type 2 diabetes (as an early marker of endothelial dysfunction and a predictor of cardiovascular complication) on the background of pathogenetic therapy with glycosaminoglycans sulodexide was done. Clinically significant reduction in the excretion of both total protein and albumin in the urine was found. It indicates an improvement of microcirculation in the kidney along with an increase in glomerular filtration rate. The increase in the glomerular filtration rate is most pronounced in patients with type 2 diabetes with comorbid non-alcoholic fatty liver disease.

scholarly journals Current ethical issues of clinical trials of drugs for the pathogenetic therapy of multiple sclerosis in the context of the COVID-19 pandemic

2021 ◽  
Vol 13 (1S) ◽  
pp. 69-72
Author(s):  
E. V. Ivashkova ◽  
A. M. Petrov ◽  
M. V. Votintseva ◽  
I. D. Stolyarov
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Trials ◽  
Immunosuppressive Therapy ◽  
Ethical Issues ◽  
Ethical Standards ◽  
Ethical Aspects ◽  
Medical Institutions ◽  
Immune Mediated ◽  
Pathogenetic Therapy ◽  
Coronavirus Infection

The spread of the COVID-19 pandemic posed a serious challenge for scientific and clinical medical institutions in terms of research for new multiple sclerosis (MS) treatments. In this review we discuss the associations between coronavirus infection and MS and provide data on the features of MS pathogenetic therapy during a pandemic. We also analyze the ethical aspects of clinical trials, the problems faced by researchers and patients, especially when using immunosuppressive therapy for MS. We provide examples of violations during research caused by the influence of a pandemic, as well as ways of solving them. Improving ethical standards is an essential component of ensuring the safety of MS and other immune-mediated diseases treatment.

scholarly journals Effectiveness of pathogenetic therapy for infectious diarrhea in children with COVID-19

2020 ◽  
Author(s):  
D. A. Khavkina ◽  
T. A. Ruzhentsova ◽  
R. V. Popova ◽  
P. V. Chukhliaev ◽  
A. A. Garbuzov ◽  
...  
Keyword(s):  
Treatment Recommendations ◽  
Diagnosis And Treatment ◽  
Gastrointestinal Disorders ◽  
Basic Information ◽  
Infectious Diarrhea ◽  
Gastrointestinal Manifestations ◽  
Intestinal Infections ◽  
Pathogenetic Therapy ◽  
Coronavirus Infection ◽  
Current Standards

Introduction. The article presents basic information on approaches to pathogenetic therapy of acute intestinal infections. Data from our own research on the diagnosis and treatment of gastrointestinal manifestations of COVID-19 in children aged 3 months to 18 years are presented. The aim of the study was to evaluate the effectiveness of complex rehydration, cytomucoprotective and probiotic therapy for infectious diarrhea of various etiologies, including those developing with a new coronavirus infection.Materials and methods. We analyzed data from our own observations of patients aged 3 months to 18 years with diarrhea against the background of acute intestinal infections of various etiologies (120 children)), as well as with a new coronavirus infection caused by the SARS-CoV-2 virus (32 children). The children were treated in accordance with current standards and treatment recommendations. Clinical examples are presented.Results and discussion. Diarrhea was observed in 64% of patients with a new coronavirus infection. Clinical cases confirm the effectiveness of rehydration, cytomucoprotective and probiotic therapy for infectious diarrhea, regardless of the etiology, including COVID-19.Conclusions. Diarrhoea and other symptoms of gastrointestinal disorders in COVID-19 are stopped when pathogenetic therapy is recommended for patients with acute intestinal infections.

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